The most important button in a hospital room and why patients need to press it

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Going to hospital for any reason can be daunting. It’s not a place most people want to spend a lot of time, and patients certainly don’t want to stay for longer than expected. Clinical Nurse Sarah Schnaak from The Prince Charles Hospital spoke about how patients can stay well in hospital, and being April No Falls month, the button she wants every patient to press to help them do so.

Falls in hospital

As we age, we become more susceptible to falling in ways that can cause serious, possibly life-threatening, harm. But falls aren’t just reserved for the elderly: anyone of any age can fall in a potentially dangerous way, especially if they’re already unwell or injured.

When patients fall in hospital, the consequences can be dire.

There are many reasons why a person might be more likely to have a fall while in hospital. They might be given medication that can make them dizzy or unsteady on their feet, which can lead to falls when they get out of bed.

Some patients will experience incontinence or needing to go to the toilet often or in a rush because of medication or changes in routine. In fact, 40% of falls in hospital happen when patients try to go to the toilet unassisted.

Sarah says that patients don’t always realise that heading to the loo in hospital might be a whole different ballgame to going at home.

“In hospital the distances are often greater to get to the toilet than at home,” explains Sarah. “There’s also often obstacles like medical equipment and furniture in the way, and a lot of these are on wheels, which can pose an added danger.”

“The patients are already unwell. You add to that changes in medication, changes in environment and reduced levels of independence, and it becomes clear why we consider all of our patients at risk of falling in hospital.”

The dire consequences of falls

When a person falls in hospital, they can end up with more serious injuries or illness than the condition that saw them admitted in the first place. Some patients have to stay in hospital for extra days or weeks after a fall, while for others, a fall can be fatal.

Sarah explains that a fall can have impacts far beyond the initial injuries of the patient.

“Falls can have devastating consequences, no doubt about it,” she says. “A patient who was expected to stay for two to three days can have a fall, then require a hip replacement and then rehab, which extends their length of stay sometimes by months. It impacts on their length of stay, their confidence level, and sometimes on their ability to return home: some of them end up in care facilities. It’s devastating for both the patients and the staff involved.”

The good news is that there are simple ways to prevent patients from falling in hospital.

Call, don’t fall

Some patients worry that calling for a nurse to help them get to the toilet will waste the nurse’s time, while others feel like the process isn’t dignified. It’s important for nurses to reassure patients that calling for a nurse is the best thing they can do.

“As nurses our first priority is to keep patients safe from harm, so never feel bad about pressing the buzzer. Patients calling for assistance when they need it, is far preferable to the time and complexity of care required for patients that have fallen,” Sarah said.

Nurses should encourage patients to call for assistance to go to the toilet as soon as they need to go, rather than waiting until they’re desperate and more likely to risk going alone.

“Patients often wait until the last minute before they press the call bell. Usually that’s because they don’t want to bother staff or they’d rather to wait until the nurse has come back and then ask for assistance. But by that time, it’s often too late.”

Helping patients to have a plan

It’s important for patients to talk to a nurse or doctor about a toileting plan for their stay in hospital. For patients, being in hospital is generally a new experience and they are unfamiliar with processes familiar to nurses. It’s important that patients know that there are no silly questions to ask – like finding out how often they should expect to go to the toilet, for example, after surgery or when on an IV, who should help them, what kind of footwear will be best and whether there are any side effects from medical procedures or treatments that might impact their toileting.

“Each patient is individual; we need to tailor their continence plan for the individual because everybody is different. If a patient tells me that they have frequency overnight, then I would put that on their plan of care. Then there are some patients that sleep through the night and they don’t need to get up at all.”

Carers, family or friends can assist with these kinds of conversations and should be encouraged to do so. The amount of information a patient receives in hospital can be overwhelming, so it can help to have someone else there at the time to ask questions and take notes, and later to remind the patient of what’s been discussed.

“People like to remain independent even though they are unwell, and that’s another big factor that may increase a person’s falls risk. Of course that varies from person to person,” says Sarah. “Having the family also assist with reinforcing the message to please call for help when you need it – that’s why the nurses are there – is invaluable.”

More information on falls

April No Falls 

Queensland Stay On Your Feet 

DynaMed Plus Topic: Falls in the Elderly

Clinical Care Standard - Falls Prevention

Falls Prevention in Australian Nursing & Midwifery Journal

Insights into the climate of safety towards the prevention of falls among hospital staff