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
______________________________
High-risk for Falls
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)
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.
2.
3.
4.
5.
6.
7.
8.
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
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 halflife 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
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.