Medical-Surgical Nursing 8th Edition by Donna Ignatavicius , Linda Workman

Exercise 4

An 82-year-old alert and oriented woman was admitted with a diagnosis of congestive heart failure. She also has urinary frequency.
You notice on her chart that she is a "high falls risk." Over 70% of patients on your unit are also at high risk for falls. The written policy and procedure for fall prevention at your hospital states that patients at risk for falling should have:
• Their health care record flagged with a yellow flower
• A yellow flower placed on their room or bed
• A bed alarm installed
• Their siderails up at all times, except when a visitor, nurse, or nursing assistant is present
The patient felt the urge to urinate and pressed her call light. Someone on the intercom told her that she would assist her shortly. After 15 minutes, the patient had to make a decision to either urinate in bed or climb over the siderails to go to the bathroom. She decided to climb over the siderails and fell. The bed alarm went off after she left the bed.
In a population of adult inpatients, what are the factors that have been shown by research to be the most predictive of falls?