Preventing falls in the Obstetric patient

1. Preventing falls in the Obstetric patient National Patient Safety Goal Many tools available for the elderly (Morse, Hendrich II, Spartanburg) No known tools for OB patients Current tools lack sensitivity & specificity for OB patients Therefore, Are they any use at all???

2. Many consider OB patients to be low risk for falls Effects of epidural + Need for early ambulation ______________________________ High-risk for Falls

3. Statistics about falls in the hospital • Falls occur more often in younger age groups • One study over 7 year period showed out of 19,593 falls, 60% occurred in patients age 10-64. • The highest percent of injury occurred in ages 20-24 years old • The frail elderly tend to have the most devastating injuries. (more attention)

4. Screening Tools • Screening tools that rely on intrinsic, patient-related factors rather than assessment of functional status have very poor predictive value • Assessment tools based on functional status are far more accurate at identifying those at risk for falling • Get up and go test

5. The Post Epidural Fall Risk Assessment Score or PEFRAS • Developed by Brenda J. Frank, MSN, RNC-OB, CCE Carrie Lane, MSN, RN Heather Hokanson, MSN, RN

6. Assesses 8 areas • History of having an epidural or a fall • Hours since epidural turned off • Ability to lift legs & bottom off bed • History of opioid administration before or after delivery • Unstable BP • Preexisting disease states • EBL >500 ml • Test stand

7. History of Falls has been established as a risk factor for additional falls • Women who have had epidurals in the past are familiar with the sensations in the lower extremities and may attempt to ambulate without assistance

8. Typical epidural with fentanyl and bupivacaine or ropivacaine has a half-life of two-six hours. • Lifting hips off bed assesses if the patient is still experiencing motor blockade. • The use of narcotics increases the risk of falls • Unstable BP/ decreased circulating blood volume increases risks of falls

9. Higher than normal EBL – lower blood volume potentiates hypotension and hypovolemia • Diabetes can cause lower extremity peripheral neuropathy • Pre-Eclampsia-may be S/P Magnesium Sulfate therapy with smooth muscle relaxation/weakness

10. Assess functional status • Have the patient stand, unassisted at the side of the bed and bend both knees and then return to standing with knees locked

12. If the patient’s risk factors equal or are greater than 50 points, then documented steps should be taken to prevent falls and appropriate nursing care plans and orders should be implemented

13. References