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Course: Fundamentals of Nursing

Topic: Home Safety

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the safety risks for home care of clients.
Discuss the nurse’s role in assessment and prevention of home injury to clients.
Provide client education to prevent falls.

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Falls

Falls are the second leading cause of unintentional injury deaths worldwide.
Each year an estimated 684 000 individuals die from falls globally of which over 80% are in low- and middle-income countries.
Adults older than 60 years of age suffer the greatest number of fatal falls.
37.3 million falls that are severe enough to require medical attention occur each year.

WH0, 2021

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Home Hazards

CDC, 2017

The common home hazards are:

Falls:

One out of five falls causes a serious injury such as broken bones or a head injury^.1.
Each year, 3 million older people are treated in emergency departments for fall injuries.
Falls are the most common cause of traumatic brain injuries.

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Home Hazards

CDC, 2017

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What would the nurse do?

You are a nurse taking care of olders clients in Geriatric Ward. As a nurse who do you consider for having risk of fall? (Select all that apply)

A client with a problem with one of their senses
A client with mobility problems
A new client who is able to communicate and ambulate well
A client who is confused
A client how has lost 10 pounds in the past 3 months

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Causes of a Fall

CDC, 2017

The conditions that make an individual more likely to fall include:

Body weakness
Vitamin D deficiency
Difficulties with walking and balance
Vision problems
Foot pain or poor footwear
Use of medicines (tranquilizers, sedatives, or antidepressants)
Home hazards or dangers such as

broken or uneven steps, and
throw rugs or clutter that can be tripped over

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Home Hazards

National Capital Poison Center, 2021

Poisoning:

In 2019, the 55 U.S. poison control centers provided telephone guidance for over 2.1 million human poison exposures:²

6.4 poison exposures/1000 population,
37.4 poison exposures in children younger than 6 years/1000 children,
1 poison exposure reported to U.S. poison control centers every 15 seconds

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Poison Prevention

Stay Safe. org, n,d

Store paint and pesticides in garages and sheds that are locked and on high shelves away from children.
Monitor children and do not leave them unattended.
Label all unmarked containers and do not store products in food containers.
Have the details of the poison control centre number in your area to hand and have it stored on your mobile phone.

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Drowning

Drowning is the 3rd leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths.

There are an estimated 236 000 annual drowning deaths worldwide.

Global estimates may significantly underestimate the actual public health problem related to drowning.

Children, males and individuals with increased access to water are most at risk of drowning.

WHO, 2021

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Home Hazards

CDC, 2017

Drowning:

Most drownings among children ages 1 to 4 occur in home swimming pools.
Most drowning under 1 year occurs in bath tubs.
Drowning ranks fifth among the leading causes of unintentional injury death in the United States.

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Drowning Prevention

Gate your pool off properly.
Attend to babies or toddlers in the bathtub 100% of the time. Never leave them alone.
Do not leave large open containers of water in the yard or in the house unattended. Examples: cleaning buckets and kiddie pool.
Cover hot tubs all the time and secure the covers so they don’t slip off easily.
Check and replace all drain covers in a pool.
Do not interact with pools or bathtubs when consuming alcohol or prescription drugs.

Safehome.org, 2021

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Home Hazards

National Fire Protection Association

Home fires and Burns:

Cause 75% of fire deaths and 73% of fire injuries by home fire.
Every 24 seconds, a fire department in the United States responds to a fire somewhere in the nation.
Cooking fire are the top cause of home fire and home injuries.
causes of home fire also include:

Heating equipment
Electricity
Smoking

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Preventive Measures of Home Fire

Keep candles and other sources of open ﬂames out of reach of children and away from anything ﬂammable.
Stay with your food when you cook. Cooking ﬁre is most likely to occur when the stove is unattended.
Use the back burners of stoves so children can't accidentally knock over pots or grab something hot.
Keep chimneys and dryer exhausts well-ventilated and free of ﬂammable buildup by cleaning them regularly.
Install and maintain smoke detectors throughout your home.

SafeHome. Org, 2021

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Preventive Measures of Home Fire

Put smoke alarms in every bedroom and outside each sleeping area.
Keep space heaters at least a few feet away from anything flammable, like blankets, clothing, and curtains.
Keep ﬁre extinguishers in common areas like the kitchen, near the ﬁreplace, and near other sources of heat.
Keep the water heater at a low temperature of 120 degrees or less children could get burned by the water when they bathe or wash their hands.
Keep curling and clothes irons out of reach of children.

SafeHome. Org, 2021

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Choking

SafeHome. Org, 2021

Choking is a hazard for small children who have a tendency to put small objects in their mouths.
Obstructed airways can be fatal and are divided into three main types:

Suﬀocation
Choking and
Strangulation

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Preventive Measure of Choking

Make sure children chew their food thoroughly and don't swallow large bites.
Cut up a child's food into fingertip-sized pieces.
Inspect toys for small pieces that could come oﬀ easily.
Check the ground regularly for small items like bits of toys, hard foods, marbles, and jewelry that children could easily choke on.
Avoid serving peanuts, seeds, popcorn, chewing gum, whole grapes, and hard candy to children younger than 4 years.

SafeHome. Org, 2021

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Preventive Measure of Suffocation

Put child-resistant locks on airtight spaces like fridges to ensure a child doesn't crawl in and get stuck.
Use cribs with a safe slat distance.
Keep plastic bags out of a child’s reach. Children are at risk of getting the bags wrapped around their heads and suffocating themselves.
Choose the firmest mattress. Check that it springs back quickly and fits well in the crib.
Avoid keeping anything else in the crib of a child younger than 1 year such as pillows and quilts.

SafeHome. Org, 2021

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Preventive Measure of Strangulation

Keep all window cords tied down, with ends cut so they aren't a loop.
Do not put necklaces and headbands on infants.
Avoid hanging bags and purses on chairs, cribs or anywhere a toddler could reach.
Cut drawstrings on hoodies, waistbands, and other clothing items for your children.
Keep an eye on babies in a stroller, as they could end up getting stuck in the straps and strangled.

SafeHome. Org, 2021

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Critical Thinking Question

What are the common foods that can lead to choking in children?

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Multifactorial Assessment for the Prevention of Fall

Ensure that any multifactorial assessment identifies the patient’s individual risk factors for falling which include:

Cognitive impairment
Continence problems
Falls history, including causes and consequences (such as injury and fear of falling)
Footwear that is unsuitable or missing
Medication
Postural instability,
Mobility problems and/or balance problems
Syncope syndrome
Visual impairment

NICE, 2013

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Multifactorial Fall Risk Assessment

Multifactorial assessment may include the following:

Identification of falls history
Assessment of gait, balance and mobility, and muscle weakness
Assessment of osteoporosis risk
Assessment of the older person’s perceived functional ability and fear relating to falling
Assessment of visual impairment
Assessment of cognitive impairment and neurological examination
Assessment of urinary incontinence
Assessment of home hazards

NICE, 2013

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Fall Risk Assessment

An approach developed by the CDC called STEADI (Stopping Elderly Accidents, Deaths, and Injuries) is used by many health care providers for fall risk assessment
STEADI includes: screening, assessing, and intervention

Screening: Three key questions for clients during screening include:

Feels unsteady when standing or walking?
Worries about falling? Has fallen in past year?
If YES ask, “How many times?” “Were you injured?”

If Yes to any question, clientis at risk of fall

Midline Plus, 2021

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Fall Risk Assessment

Assessment

Assess client modifiable risk factors and history of fall
Common ways to assess fall risk factors are listed below:

A.Evaluate gait, strength, & balance using the following fall assessment tools:

1.Timed Up-and-Go (Tug):This test checks the gait

Clients start in a chair, stand up, and then walk for about 10 feet at your regular pace.
Then sit down again. The health care provider will check how long it takes you to do this. If it takes you 12 seconds or more, it may mean you are at higher risk for a fall.

Medline Plus, 2021

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Fall Risk Assessment

2. 30-Second Chair Stand Test:

To checks strength and balance.
The client sit in a chair with your arms crossed over your chest.
When the provider says "go," the client stand up and sit down again. Repeat this for 30 seconds.
The provider will count how many times a client can do this.
A lower number may mean you are at higher risk for a fall. The specific number that indicates a risk depends on age.

Medline Plus, 2021

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Fall Risk Assessment

3. 4-Stage Balance Test:

This test checks how well clients can keep their balance
Clients stand in four different positions, holding each one for 10 seconds.

Position 1: Stand with your feet side-by-side.
Position 2: Move one foot halfway forward, so the instep is touching the big toe of your other foot.
Position 3 Move one foot fully in front of the other, so the toes are touching the heel of your other foot.
Position 4: Stand on one foot.

Medline Pllus Org, 2021

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Preventive Measure of a Fall

Talk to Doctors/ Health care professionals:

To evaluate the risk of falling.
To review your medicines to see if any might make you dizzy or sleepy.
Talk to the doctors or health care provider about specific things can be done to reduce the risk of fall.

Do Strength and Balance Exercises:

Exercises that make your legs stronger and improve your balance.
Tai Chi is a good example of this kind of exercise.

CDC, 2017

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Preventive Measure of a Fall

Have Eyes Checked:

Get eyes checked by an eye doctor at least once a year,
Be sure to update your eyeglasses if needed

Make a Home Safer:

Get rid of things you could trip over
Add grab bars inside and outside your tub and next to the toilet
Put railings on both sides of stairs
Make sure a home has lots of light by adding brighter light bulbs

CDC, 2017

Contact info: info@nursesinternational.org

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Multifactorial Intervention for Prevention of Fall

NICE, 2013

Strength and balance training.
Home hazard assessment and intervention.
Vision assessment and
Referral medication review with modification/withdrawal
Cardiac pacing
Encouraging the participation of older people in falls prevention programmes

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Universal Fall Precautions for Nurses

Familiarize the client with the environment.
Have the client demonstrate call light use.
Maintain call light within reach.
Keep the patient's personal possessions within client safe reach.
Have sturdy handrails in client bathrooms, rooms and hallways.
Place the hospital bed in low position when a client is resting in bed; raise bed to a comfortable height when the clientis transferring out of bed.

Spring Arbor University, 2021

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Universal Fall Precautions for Nurses

Keep hospital bed brakes locked.
Keep wheelchair wheel locks in "locked" position when stationary.
Keep non slip, comfortable, well-fitting footwear on the patient.
Use night-lights or supplemental lighting.
Keep floor surfaces clean and dry, and clean up all spills promptly.
Keep client care areas uncluttered.
Follow safe client handling practices.

Spring Arbor University, 2021

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Education for Preventing Fall

Educating the client and family/caregiver about the risk of falling, safety issues, and activity limitations.
Teaching clients to make position changes slowly.
Orienting clients to their bed area, ward facilities, and how to get assistance.
Education programs for all new and high risk clients.
Information on the aftermath of a fall.
Psychological issues.
Informed choices around risk.
Importance of staying active and being mobile; and
Osteoporosis (i.e., promoting “Healthy Bones.

Registered Nurses’ Association of Ontario, 2005

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Role of Nurses in Fall Prevention Programs

Completing and documenting client fall risk screening and assessment.
Documenting patient-specific fall prevention practices.
Monitoring the patient’s medical condition for any changes.
Reporting falls to the physician.
Obtaining medical orders from the physician as needed.
Supervising nursing aides.
Educating the client and family on fall prevention.
Obtaining the supplies (cane, walker, bed alarm, etc.) need to prevent client falls.

Performance Health, 2020

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Role of Nurses in Fall Prevention Programs

Nursing aides also play a part in preventing client falls including:

Evaluating the patient’s environment for safety during client care tasks.
Performing care plan tasks and reporting to nurse when tasks are complete.
Reporting any changes in a patient’s medical condition to a nurse.

Performance Health, 2020

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Critical Thinking Question

What are multifactorial intervention for prevention of fall? Select all that apply

Strength and balance training
Home hazard assessment and intervention
Vision assessment
Referral medication review with modification/withdrawal
Cardiac pacing

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Reference:

Center for Disease Control and Prevention (CDC), (2017). Important Facts about Falls. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Fall prevention: preventing falls at home (https://youtu.be/SW7w5EkkEMM)

Midline Plus, (2021). Fall Risk Assessment. https://medlineplus.gov/lab-tests/fall-risk-assessment/

National Institute of Health and Care Excellence (NICE), (2013). Assessment and prevention of falls in older people. https://www.nice.org.uk/guidance/cg161/evidence/falls-full-guidance-190033741

Contact info: info@nursesinternational.org

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Reference:

Performance Health, (2020). The Role of Nurses in Fall Prevention. https://www.performancehealth.com/articles/the-role-of-nurses-in-fall-prevention#4

Registered Nurses’ Association of Ontario, (2005). Prevention of Falls and Fall Injuries in the Older Adult. https://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf

SafeHome. Org, (2021). A Guide to Home Safety: Identifying and Preventing Hazards. https://www.safehome.org/resources/home-hazards/

Contact info: info@nursesinternational.org

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References:

Spring Arbor University, (2021). Advanced Nursing and Your Role in Fall Prevention. https://online.arbor.edu/news/advanced-nursing-and-your-role-fall-prevention

StaySafe. Org, (2018). SAFETY AT HOME: 10 COMMON SAFETY HAZARDS AROUND THE HOUSE.https://staysafe.org/safety-at-home-10-common-safety-hazards-around-the-house/

World Health Organization, (2021). Falls. https://www.who.int/news-room/fact-sheets/detail/falls

World Health Organization, (2021). Drowning. https://www.who.int/news-room/fact-sheets/detail/drowning

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