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???

Many consider OB patients to be low risk for falls

Effects of epidural

+

Need for early ambulation

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High-risk for Falls

Statistics about falls in the hospital

Falls occur more often in younger age groupsOne 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 oldThe frail elderly tend to have the most devastating injuries. (more attention)

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

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

Assesses 8 areas

1. History of having an epidural or a fall2. Hours since epidural turned off3. Ability to lift legs & bottom off bed4. History of opioid administration before or

after delivery5. Unstable BP6. Preexisting disease states7. EBL >500 ml8. Test stand

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

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 fallsUnstable BP/ decreased circulating blood volume increases risks of falls

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

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

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

References

Frank, B., Lane, C., & Hokanson, H. (2009). Designing a postepidural fall risk assessment score for the obstetric patient. Journal of Nursing Care Quality , 1, 50-54.

Hendrich, A. (2007). Predicting patient falls: Using the Hendrich II fall risk model in clinical practice. AJN , 107 (11), 50-58.

Robey-Williams, C., Rush, K., Bendyk, H., Patton, L. M., Chamberlain, D., & Sparks, T. (2007). Spartanburg fall risk assessment tool: A simple three-step process. Applied Nursing Research , 20, 86-93.