The Impact of the Coronavirus Pandemic on Fall Precautions

Kathy Quan RN BSN PHN

Kathy Quan RN BSN PHN

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Many patients who are recovering from the novel Coronavirus (SARS-2-COVID-19) find themselves in a precarious situation. After being bedbound for a few days, weeks, or even months, have discovered their muscles will have atrophied and they will need to strengthen them and learn to stand alone and walk all over again. This can make rehabilitation a lengthier process for most. The weakness, the ongoing shortness of breath, the brain fog, the heightened anxiety levels, and the generalized debilitation from the pandemic illness will all play a huge role in the recovery process. These symptoms also impact the fall risk for each patient.

Most patients will not understand the total affect their illness has had on their body and are anxious to get out of bed and get home as soon as possible. Left alone in their room, it’s quite possible many of these patients will fall out of bed or face plant just trying to stand up. After five days on bedrest, the muscle tone will be lost. Patients are not always aware of this and must be reminded to ask for assistance with all mobility. Any explanation of why will be of utmost importance to elicit their cooperation. In situations where care is being clustered for COVID-19 patients, wait times for assistance can be longer and can be cause for more falls when the need is urgent such as toileting. Careful planning and patient education is of greater importance for prevention of falls and injuries. 

Falls are an important factor in healthcare. According to the World Health Organization (WHO), falls are the second leading cause of death worldwide from unintentional injury. The first is traffic accidents. If the falls are not fatal, serious injury and resulting disabilities frequently occur. The WHO estimates about 37.3 million falls that require medical attention happen each year throughout the world. Of those, approximately 646,000 falls will result in deaths. 

The Centers for Disease Control and Prevention (CDC) estimates that in 2015, over $50Billion was spent on medical costs related to falls in the US alone. Medicare and Medicaid absorbed about 75% of this cost. Over 3 Million people are treated in Emergency rooms each year for fall injuries. Out of the nearly 800,000 annual hospitalizations due to falls, 300,000 are for hip fractures. Hip fractures and head injuries are the most common injuries while most of the traumatic brain injuries are due to falls. 

The two major age groups generally affected by falls are children and adults over 65. Some of the largest reported cases of COVID-19 are affecting the population 64 and over. When the pandemic is factored in, even younger people 20-40 years old are high fall risks due to the effects of long bedrest.

In an effort to protect the public and prevent the spread of the pandemic, most hospitals and facilities have severely restricted visitors to areas such as Labor and Delivery, and some Pediatric or Surgical units, if at all. Although visitors can sometimes be an annoyance, it has become a norm for them to be with loved ones for hours on end. Nursing staff has become accustomed to visitors helping to care for patients’ basic needs and making requests on their behalf. Without visitors present to assist and advocate, all of the patient needs fall on the nurses to be met. Nursing assistants are also rarely used on COVID-19 units. Care planning has definitely changed. 

Preventing falls is essential, but the pandemic is impacting the success. One of the most obvious ways to prevent risk is by utilizing side rails, but a determined patient desperate to get to the commode or bathroom may put himself at further risk by attempting to climb over the rails increasing the danger and complications of a potential fall. Donning and doffing PPE adds significantly to the response time as does the unexpected use of PPE when needs arise. 

Toileting every 2-3 hours has shown to improve fall rates, but it has to be factored into the clustering aspects as well as anticipating the unexpected. If the patient is mentally clear, knowing when to expect the next toileting can help to reduce anxiety and ally fears. However, some of the brain fog caused by the virus radically affects the patient’s ability to judge time. Secondary infections such as a UTI or bacterial pneumonia can also increase levels of confusion as well as general weakness and cause balance and steadiness. All of this must be considered in care planning. 

Having better understanding and improved skills will assist nurses in providing better quality care. Continuing education for nurses is designed around this concept. Nurses can utilize their continuing education courses to meet the challenges presented by this pandemic to improve their skills and education with courses about COVID-19. In addition, continuing education can provide education on some of the symptoms and effects of the virus. For example, a variety of anxiety disorders can be seen and are expected in patients positive for the virus. These include general anxiety disorder (GAD) and PTSD. Diabetics are having increased cardiovascular issues from COVID-19. And nurses are having to assist patients and loved ones in making difficult end-of-life decisions in real time. Explore the entire list of CE courses now available from NursingCE.com.

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