Which intervention would the nurse include in a plan of care for a hospitalized older adult to address extrinsic risk factors?

According to the Centers for Disease Control and Prevention (CDC), between 700,000 and 1,000,000 patients fall in hospitals each year. A critical aspect of a nurse's role is to proactively create a safe environment for this vulnerable population. When considering which intervention would the nurse include in a plan of care for a hospitalized older adult to address extrinsic risk factors, the focus shifts to modifying the patient's immediate surroundings.

Quick Summary

The most important intervention a nurse can include in a care plan to address extrinsic risk factors for a hospitalized older adult is to create a safe, clutter-free environment by ensuring proper lighting, removing tripping hazards, and providing appropriate assistive devices and footwear.

Key Points

• Environmental Safety: The primary intervention is modifying the patient's environment to remove all tripping hazards and ensure clear pathways.

• Proper Lighting: Ensuring adequate lighting, especially at night, is a simple yet crucial intervention to help older adults with visual impairments navigate safely.

• Assistive Devices: Providing and ensuring the correct use of assistive devices like walkers, canes, and grab bars significantly enhances patient mobility and stability.

• Low Bed Position: Keeping the hospital bed in its lowest position minimizes the distance and impact of a potential fall.

• Accessible Call Light: Placing the call light and personal items within the patient's easy reach reduces the need for them to get up unassisted.

• Non-Slip Footwear: Encouraging the use of proper, well-fitting footwear with non-slip soles is a critical intervention for safe ambulation.

• Patient and Family Education: Educating the patient and family on fall prevention strategies empowers them to participate actively in maintaining a safe environment.

Understanding Extrinsic vs. Intrinsic Risk Factors

Before detailing specific interventions, it's crucial to understand the difference between intrinsic and extrinsic fall risk factors. Intrinsic factors relate to the patient themselves—their age-related changes, medical conditions, medication side effects, and physical limitations. Extrinsic factors, on the other hand, are external environmental hazards that increase the risk of falls. A proactive nursing plan addresses both, but in this context, we will focus on the external or extrinsic factors that are within the nurse's control to modify.

Environmental Modifications for Patient Safety

Creating a safe and hazard-free environment is the cornerstone of addressing extrinsic risk factors. A nurse must perform a comprehensive environmental assessment to identify and remove potential threats to the patient's safety.

Clearing Clutter and Obstacles

• Maintain Clear Pathways: Keep the patient's room, including the path to the bathroom, free of clutter, loose wires, and unnecessary equipment.
• Secure Furniture: Ensure that all furniture is stable and does not obstruct movement. If furniture needs to be moved, ask for assistance to do so safely.
• Address Spills Promptly: Immediately clean up any spills to prevent slick surfaces that could lead to a fall.

Improving Lighting

• Maximize Illumination: Ensure the room is well-lit, as impaired vision is a common issue for older adults.
• Utilize Night Lights: Install or utilize a night light, particularly in the path to the bathroom, to aid vision during nighttime trips.

Providing Accessible Items and Equipment

• Keep Essentials Within Reach: Place the patient's call light, water, glasses, phone, and other frequently used personal items within easy reach to prevent them from overstretching or getting out of bed unnecessarily.
• Ensure Proper Placement: Confirm that assistive devices such as walkers or canes are placed where the patient can easily access them.

Nursing Interventions Related to Equipment and Devices

Beyond environmental cleanup, the nurse's role involves ensuring that all equipment and devices are used correctly and safely to minimize risk.

Optimal Bed and Chair Positioning

• Lowered Bed Position: Always keep the patient's bed in the lowest possible position when they are resting.
• Lock Brakes: Ensure the brakes on beds, wheelchairs, and commodes are always locked when stationary to prevent unexpected movement during transfers.
• Adjustable Seating: Provide a chair with armrests and a high back for support, and adjust it to a height that allows the patient to sit down and stand up with ease.

Providing Proper Footwear

• Non-Slip Soles: Encourage and assist the patient in wearing well-fitting shoes or slippers with non-slip soles at all times while out of bed.
• Avoid Hazards: Advise against walking in socks, stockings, or bare feet, as these increase the risk of slipping.

Utilizing Alarms and Sensors Appropriately

• Bed or Chair Alarms: Implement bed or chair alarms for patients identified as high fall risks to alert staff when the patient attempts to get up unassisted.
• Consider Alternatives: Understand that some studies have shown bed alarms are not associated with significant falls reduction, and a multifactorial approach is often more effective. Use professional judgment in applying these interventions based on individual patient needs.

Patient and Family Education

Educating both the patient and their family is a powerful and non-invasive intervention that can significantly reduce extrinsic risk factors. The nurse serves as a crucial educator in this process.

• Orientation to the Environment: Familiarize the patient with their new hospital environment, showing them how to operate the call bell, bed controls, and how to safely access the bathroom.
• Use of Assistive Devices: Demonstrate the proper use of any walking aids and ensure the patient feels comfortable and confident using them.
• Encourage Slow Movements: Remind the patient to move slowly when getting up from a lying or sitting position to standing, allowing time for their balance to adjust.
• Emphasize Asking for Help: Teach the patient that it is never a bother to ask for assistance, and emphasize that they should always use their call light for help.

Comparison of Key Extrinsic Interventions

Intervention	Description	Benefit	Consideration
Environmental Clearing	Systematically removing clutter, cords, and spills from the patient’s path and room.	Eliminates immediate tripping and slipping hazards.	Requires constant vigilance and cooperation from the patient and visitors.
Proper Lighting	Ensuring adequate light, especially with night lights, to improve visibility.	Compensates for age-related vision changes and confusion during nighttime hours.	Needs proper placement to avoid glare and shadows that could be confusing.
Non-Slip Footwear	Providing and encouraging the use of shoes or slippers with textured soles.	Increases friction and stability on hospital floors.	Requires proper fit; ill-fitting footwear can also be a hazard.
Lowered Bed Position	Adjusting the hospital bed to its lowest setting when the patient is resting.	Reduces the distance of a potential fall if the patient attempts to get out of bed unassisted.	May require raising for patient care or transfers, so consistent re-adjustment is key.
Accessible Items	Keeping personal items and the call bell within easy reach.	Reduces the patient’s impulse to stretch, reach, or get up unassisted.	Requires active and ongoing assessment of the patient's needs and movements.

Conclusion: A Multi-Layered Approach to Safety

Addressing extrinsic risk factors for a hospitalized older adult is a core component of patient safety. By implementing a multi-layered approach that includes rigorous environmental management, proper use of assistive equipment, and comprehensive patient and family education, nurses can significantly reduce the risk of falls. This proactive care plan not only prevents injury but also fosters a culture of safety that benefits all patients. It acknowledges that while intrinsic factors may be challenging to modify, the patient's environment is fully within the care team's control to optimize for the patient's well-being. By focusing on these interventions, nurses play a direct and impactful role in the healthy aging of their hospitalized patients.

For more detailed information on fall prevention strategies and best practices in nursing, consider consulting resources from trusted healthcare organizations like the Agency for Healthcare Research and Quality (AHRQ): https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod3sess2.html.

Frequently Asked Questions

What is an extrinsic risk factor for a fall in the hospital setting?

An extrinsic risk factor is an external or environmental hazard that increases the likelihood of a fall. Examples include poor lighting, wet floors, cluttered pathways, and ill-fitting footwear.

Why are older adults more susceptible to extrinsic risk factors?

Older adults are more susceptible because of intrinsic factors like potential vision changes, decreased balance, and medication side effects. These individual vulnerabilities make them less able to compensate for extrinsic hazards that a younger person might easily navigate.

How does a nurse address extrinsic risk factors related to lighting?

A nurse can address lighting by ensuring the patient's room is well-lit, adding a night light, and making sure the path to the bathroom is clear and visible, especially at night.

Are bed alarms an effective intervention for addressing extrinsic risk factors?

While bed alarms can alert staff when a patient tries to get out of bed, research suggests they are not associated with a significant fall reduction and are often part of a larger, multifactorial intervention plan. They primarily address the risk of unassisted transfers rather than the root environmental cause.

What role does proper footwear play in preventing falls?

Wearing well-fitting, supportive, and non-slip footwear provides better traction and stability on hospital floors, reducing the risk of slipping or tripping. A nurse should ensure the patient is not walking in bare feet or socks.

How can a nurse ensure the patient’s personal belongings don't become a risk?

A nurse should keep all frequently used personal items, such as the call light, phone, and glasses, within easy reach of the patient to prevent them from stretching or reaching in an unsafe manner.

Should a nurse involve the patient's family in extrinsic fall prevention?

Yes, family involvement is critical. Nurses should educate family members about the patient's fall risk and encourage them to help maintain a safe environment, such as by keeping pathways clear and reminding the patient to ask for help.