Falls and Hourly Rounding

A fall is an unplanned descent to a lower level, whether or not the person is injured. The event is not merely an environmental accident. It may reveal acute illness, medication effects, impaired balance, unsafe mobility, cognitive change, or a mismatch between the person's abilities and the assistance available. An experienced nurse notices change from baseline before relying on a risk score. A person who usually transfers independently but is now reaching for furniture, rushing to the toilet, appearing drowsy, or asking repeatedly for help has a changing risk profile. New unsteadiness or confusion may be the first visible sign of infection, hypoxia, hypotension, hypoglycaemia, stroke, delirium, or medication toxicity. The fall-prevention response must therefore address both the immediate hazard and the reason the hazard appeared. Risk usually accumulates rather than coming from one cause. A patient taking an opioid after surgery may be sleepy and dizzy when standing. Add urgent nocturia, unfamiliar surroundings, poor lighting, and a call bell out of reach, and an otherwise manageable transfer becomes hazardous. Removing only one factor may not make the transfer safe....