Hi guys,
I had a pt who recently was discharged back home. This 81 yo lady came into the ward for a gastric outlet obstruction, and I was treating her chest during her stay. I found out from her daughter that she had multiple falls at home in the past as she tends to clutter her house such as tripping on the carpet. She has poor standing balance, lives alone at home and is awaiting bilateral cataract removal. Her daughter expressed her concerns re. the pt's safety at home. As I ambulated this pt on the ward during her stay, she was intermittently unsteady at times especially on turns, and relies heavily on her hands.
Considering all these factors, I made it very clear in my notes that the pt was still not safe for discharge at that time as she was a falls risk. However, she made a remarkable improvement in her mobility over the weekend, and the team was pressing for her discharge home - she was ambulating around the ward independently. The problem was - I wasn't entirely sure whether she was really safe: her mobility was much improved from what the ward could see, but I kept going through all those risk factors in my head, it was just this "gut feeling" I had. In the end, she was discharged home with RITH, and I referred her for falls clinic - I've expressed all my concerns in her notes.
The problem I had was that her Hx implies a falls risk, whereas the patient was walking around the ward independently and safely. Which did I have to rely on to make the decision whether she was really safe - what you know vs what you see?
It's those pts who are borderline that I struggle with. I hope that with more exposure, I'd learn to be more certain with making such decisions. I've learnt to use different services to send pts home with that have helped to make decisions easier (RITH, falls clinic, community physio etc.) Falls are so multi-factorial and I don't want miss something important and end up with a pt coming back in for a NOF.
Do you guys face similar problems? Or maybe it's just me...haha.
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Mark, I ve come across almost the exact same situation many times!! I have trouble with the borderline pts aswell. Ive been in the situation where the Doctors want to DC the pt but I am a bit iffy about thier safety in terms of mobility and balnce. In these situations I take advantage of the fact that we have a supervisor and discuss my concerns with her to come to a decision. Most of the times in this situation the outsome was simialr to yours. I was a bit worried about the pt, especially if they live alone, but have sent them home with RITH and a referral for a falls clinic. However, if I am certain they are unsafe, obviously I re-iterate that they are not safe for DC and organise further rehab or a second Ax and opinion from my supervisor. I guess with more clinical experience we will become better at judging when a pt is safe doe DC or not, but for the moment Id prefer to er on the side of caution :)
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