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Can you provide me with information regarding extrinsic fall risk factors with which I can educate my nurses?

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Patients fall for many different reasons, and most falls have more than one cause. Patients often fall during routine activities, such as walking, standing, or changing position, and approximately 50% of falls result primarily from extrinsic factors in the environment.

The first step to reducing falls is identifying the factors that put patients at risk. Some environmental hazards include:

Furniture arrangement, as arrangements can sometimes block pathways. This can be a problem in any care environment.

Floors that are too slick and changes in flooring types or levels from one room to another have all been responsible for falls, as well as wrinkled, torn, or uneven flooring of any kind. Scattered rugs without secure anchoring may slip and cause someone to trip.

Lighting that is too low is a risk factor for falls, as is lighting that is too bright and creates glares or distorts the way objects look (as can happen with colored lights).

Trailing cords or hoses from electrical devices, vacuum cleaners, or floor washers cause falls.

Temperature affects fall risk in two ways. A patient with orthostatic hypotension should avoid hot environments. This is because heat can result in vasodilation. For example, people with multiple sclerosis often find that heat exacerbates their illness. On the other hand, cold weather can make stiff joints even more inflexible. A moderate indoor temperature is best to prevent the effect of temperature extremes on either end of the spectrum.

New, unfamiliar surroundings cause falls. For example, research shows that the incidence of falls is highest during the first week a patient moves to a new environment.

Clothing that is too long is often responsible for falls. Skirts and pants that touch the floor are fall hazards.

Footwear is a major risk factor for falls. Thick, rubbery soles catch easily on carpet and cause patients to trip. Socks without treads can easily cause a fall on a slick floor.

—Carole Eldridge, DNP, RN, NEA-BC, dean, campus director, and associate professor at St. John's College of Nursing and Health Sciences at Southwest Baptist University in Springfield, MO

(July 2009)