When is a fall not a fall?

At the hospital level healthcare workers are very concerned about patient falls.

We dissect each fall as they occur and look to see if the guardrails have been in place around the patient.

Things like bed alarms on to remind the patient not to get out of bed. And to alert the healthcare workers on the unit that there are shenanigans afoot. Some places have the bed alarms wired into the call bell system as an additional alert.

There are chair alarms that function as a reminder to the patient, and an alert to the healthcare team. Much the same as the bed alarm.

There are emergency pulls in the bathrooms that someone can pull to alert others that they overjudged their stamina and endurance and are in trouble while in the bathroom.

There are safety attendants who sit with patients to remind them not to get out of bed. There are cameras that can also serve as watchers when there are not enough safety attendants available.

There is paperwork that is filled out on every fall, documenting the presence of these fail safes or absence. In some places they do a debrief after every fall.

There are special fall bracelets that serve as a visual reminder that the patient is at risk for a fall. In some places this is a conclusion for a patient after the nurse fills out a fall risk assessment.

It is understood that the patient is assessed and given a score about their likelihood of falling in the hospital. Which starts the cascade of fall precautions: the alarms, the bells, the pull station, the armbands.

But sometimes all of that is not necessary. Because sometimes a fall is an accident.

And all of the precautions in the world could have prevented it.

And sometimes it is the verbiage of a fall that starts the cascade.

I had a patient once who had all the fall precautions, even though they were under 20 with no balance issues. I was perplexed and investigated more.

Their “fall” was using a bike that someone had left on the side of the road. Did they know how to ride a bike? No. But it still counted as a fall.

Sometimes a fall is due to the very human condition of foolishness.

And that is hard to guard against.

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