The most important button in your hospital room and why you need to press it
Wednesday 18 April 2018
Going to hospital for any reason can be daunting. It’s not a place most of us want to spend a lot of time, and we certainly don’t want to stay for longer than expected.
We spoke to Clinical Nurse Sarah Schnaak from The Prince Charles Hospital about how patients can stay well in hospital, and the button she wants every patient to press to help them do so.
Falls in hospital
As we age, we become more susceptible to falling in ways that can cause serious, possibly life-threatening, harm. But falls aren’t just reserved for the elderly: anyone of any age can fall in a potentially dangerous way, especially if they’re already unwell or injured. When patients fall in hospital, the consequences can be dire.
There are many reasons why a person might be more likely to have a fall while in hospital. They might be given medication that can make them dizzy or unsteady on their feet, which can lead to falls when they get out of bed. Some patients will experience incontinence or needing to go to the toilet often or in a rush because of medication or changes in routine. In fact, 40% of falls in hospital happen when patients try to go to the toilet unassisted.
Sarah says that patients don’t always realise that heading to the loo in hospital might be a whole different ballgame to going at home.
“In hospital the distances are often greater to get to the toilet than at home,” explains Sarah. “There’s also often obstacles like medical equipment and furniture in the way, and a lot of these are on wheels, which can pose an added danger.”
“The patients are already unwell. You add to that changes in medication, changes in environment and reduced levels of independence, and it becomes clear why we consider all of our patients at risk of falling in hospital.”
The dire consequences of falls
When a person falls in hospital, they can end up with more serious injuries or illness than the condition that saw them admitted in the first place. Some patients have to stay in hospital for extra days or weeks after a fall, while for others, a fall can be fatal.
Sarah explains that a fall can have impacts far beyond the initial injuries of the patient.
“Falls can have devastating consequences, no doubt about it,” she says. “A patient who was expected to stay for two to three days can have a fall, then require a hip replacement and then rehab, which extends their length of stay sometimes by months. It impacts on their length of stay, their confidence level, and sometimes on their ability to return home: some of them end up in care facilities. It’s devastating for both the patients and the staff involved.”
The good news is that there are simple ways to prevent falls in hospital. If you’re heading to hospital, or you know someone who is, follow these steps to help you stay on your feet.
Call, don’t fall
Some patients worry that calling for a nurse to help them get to the toilet will waste the nurse’s time, while others feel like the process isn’t dignified. But Sarah wants to reassure patients that calling for a nurse is the best thing they can do.
“As nurses our first priority is to keep patients safe from harm, so never feel bad about pressing the buzzer. Patients calling for assistance when they need it, is far preferable to the time and complexity of care required for patients that have fallen.”
Sarah encourages patients to call for assistance to go to the toilet as soon as they need to go, rather than waiting until they’re desperate and more likely to risk going alone.
“Patients often wait until the last minute before they press the call bell. Usually that’s because they don’t want to bother staff or they’d rather to wait until the nurse has come back and then ask for assistance. But by that time, it’s often too late.”
Have a plan
Talk to a nurse or doctor about a toileting plan for your stay in hospital. There are no silly questions to ask – find out how often you should expect to go to the toilet, who should help you, what kind of footwear will be best and whether there are any side effects from medical procedures or treatments that might impact your toileting.
Sarah also recommends letting nurses know how often you usually go to the toilet, so they can work that into their care plan.
“Each patient is individual; we need to tailor their continence plan for the individual because everybody is different. If a patient tells me that they have frequency overnight, then I would put that on their plan of care. Then there are some patients that sleep through the night and they don’t need to get up at all.”
Carers, family or friends can assist with these kinds of conversations. The amount of information a patient receives in hospital can be overwhelming, so it can help to have someone else there at the time to ask questions and take notes, and later to remind the patient of what’s been discussed.
“People like to remain independent even though they are unwell, and that’s another big factor that may increase a person’s falls risk. Of course that varies from person to person,” says Sarah. “Having the family also assist with reinforcing the message to please call for help when you need it – that’s why the nurses are there – is invaluable.”
Understand side effects
All medications have possible side effects that can affect the person who takes them. Some medications might have side effects that make it more likely for a person to fall, like dizziness, unsteadiness or increased frequency or urgency to go to the toilet.
Speak with your doctor about the possible side effects of your medications and treatments. This can also be a good conversation to have a support person sit in on, who can take notes and remind you of the discussion later on.