Patient safety • Practical nursing guide
“I only wanted to use the toilet.” A patient may feel ready to walk before their strength, balance or blood pressure has recovered.
Fall prevention begins with knowing what that person needs to move safely today. This guide connects bedside assessment with practical decisions, using a fictional night-shift example and real photographs of relevant equipment.
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Why a patient who walks at home may need help in hospital
Illness, unfamiliar surroundings, medicines and reduced activity can make a previously independent person unsteady. Getting out of bed or finding a bathroom may become difficult. AHRQ’s Fall TIPS approach links assessment to a personalised plan that staff, patients and families put into practice consistently. [2]
The useful question is specific: “What could make this patient fall during their next transfer?” Asking that question draws attention to the actual task instead of stopping at a label such as “high risk.”
Assess the person, not just the room
A comprehensive assessment considers mobility, balance, strength, cognition, delirium, vision, hearing, continence, footwear, dizziness, cardiovascular factors, nutrition and medicines. The Royal College of Physicians emphasises identifying the individual factors that interfere with safe activity. [3]
| Ask or observe | Make the finding useful |
|---|---|
| “Have you fallen recently, or felt unsteady?” | Record what happened and what assistance is needed now. |
| How does the person sit, stand and transfer? | Communicate the assessed mobility plan and equipment requirements. |
| Any dizziness, new confusion or drowsiness? | Arrange assessment rather than assuming these are normal for age. |
| Can they see, hear and understand instructions? | Make the agreed communication and sensory support available. |
| When and how do they use the toilet? | Build assistance into the care plan before an urgent attempt to walk. |
A numerical risk score, where local policy uses one, should not replace an individual assessment. NICE advises against using falls risk prediction tools to predict whether a person will fall. The care plan needs to name the problems and actions. [1]
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Turn the findings into bedside actions
Basic precautions include an uncluttered, dry floor; suitable lighting; well-fitting, nonslip footwear; a locked bed at an appropriate height; and possessions within safe reach. Keep the bed low while the patient rests, then use the assessed transfer height when helping them out. Follow safe handling procedures and use the staff and equipment required by the plan. [4]
Orient the patient to the ward and show them how to request assistance. Ask them to demonstrate the call system. Recheck its position after care, cleaning or a transfer. A device placed correctly at the start of a shift may later be hidden under bedding. [4]
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Make toileting assistance realistic
Discuss toileting needs as part of the personalised plan. Ask the patient what makes it difficult to wait or to call for help. Agree how assistance will be provided and explain it to the next staff member. Patient and family involvement supports consistent use of the plan. [2]
This is a teaching example, not a promise about response times. The team must make the assistance arrangement workable.
Support activity with the right assistance
Keeping someone inactive is not the aim of falls prevention. The RCP describes a positive approach that enables safe activity while addressing the factors that compromise it. Involve the appropriate rehabilitation team in mobility assessment and planning. [3]
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Dizziness and medicines deserve attention
Postural hypotension is a drop in blood pressure on moving upright. It may cause lightheadedness, weakness or fainting. Report symptoms, assist the patient to a safe position and follow the clinical assessment plan. Changes of position should be gradual. A lying-to-standing measurement, when indicated, requires the appropriate procedure and support. [5]
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Some medicines can contribute to sedation, dizziness, blurred vision, confusion or low blood pressure. Review concerns with the prescriber and pharmacist, including recent changes and over-the-counter products. Nurses should report observed effects and follow authorised instructions; patients should not stop prescribed treatment on their own. [6]
A useful observation: “She became drowsy after the evening dose and now needs more help to stand” gives the reviewing clinician more information than “medication increases falls risk.” Record the medicine, dose, administration time and actual findings when relevant.
Do bed rails always make a patient safer?
No. A confused person may climb over a rail and fall from a greater height. Entrapment is another serious hazard. The decision requires an individual assessment, suitable equipment, correct fitting and review when the person’s condition or equipment changes. Explain the decision and involve the patient where possible. Rails should not be treated as a routine answer to every fall risk. [7]
What should a student nurse take from this?
Ask your supervisor how the bed rail decision was assessed and documented. Do not independently add rails or improvise equipment. A visible barrier is not proof that the whole situation is safe.
A night-shift situation: what would you do?
Fictional case: Mrs Amina, 72, is recovering from an acute illness. She normally walks independently at home. Tonight she reports dizziness on standing, is sleepier than earlier and needs to use the toilet frequently. Her slippers are loose, and her call button has slipped behind a pillow. At 02:00 she begins to get out of bed alone.
Before opening the discussion, name the immediate problem, the modifiable hazards and the information the next nurse needs.
Open the nursing discussion
Attend promptly, explain that you are there to help and assist according to the assessed handling plan. Seek additional help if needed. Dizziness and increasing sleepiness need assessment and escalation, not just a reminder to be careful. Address the inaccessible call button and unsuitable footwear, and arrange appropriate toileting support. Review the care plan with the team.
A strong handover would state what changed, how she currently transfers, what symptoms need review and what help is required for the next toilet visit. “High risk of falls” alone leaves the receiving nurse without those details.
Teaching exercise: Let one student be the patient and another explain the plan. Ask the “patient” to repeat how they will request help. Then change one detail: the patient is now confused and cannot reliably use the call button. Discuss what reassessment and supervision arrangements the team must consider. Do not assume that repeating the same instruction solves a new problem.
If a fall happens, assess before routine lifting
Call for help and assess promptly using the local post-fall pathway. Check for acute illness and injury, including possible head, neck, spine or hip injury. Do not automatically lift the person back into bed. Suspected injury requires an appropriate clinical review and a safe recovery plan; immediate life threats take priority. Keep the patient observed, reassured and appropriately warm. [8]
Document what was witnessed, what the patient reports, your findings and the care provided. Make the required incident report and update the prevention plan. A post-fall team review should identify contributing factors and changes needed to reduce recurrence. [4]
Check your understanding
1. The patient walked independently at home. Does that establish today’s assistance level?
No. Current illness, symptoms and mobility need reassessment. Hospital care may temporarily change what the patient can safely do. [2]
2. A call button is on the bedside table. Is that enough?
Check that the patient can reach it, understands it and can use it. Its location alone does not establish that it is accessible. [4]
3. Should every confused patient have bed rails raised?
No. Rails need individual risk assessment, including climbing and entrapment hazards. [7]
4. A medicine may be causing dizziness. Should the patient stop it independently?
No. Report the concern and arrange an authorised medication review with the clinical team. [6]
5. What is missing from “falls risk explained” in the nursing note?
The individual risks, the agreed assistance plan, what the patient understood and the actions actually taken. A useful note helps the next nurse continue the same plan.
A question to carry into your next shift
Before leaving a bedside, ask yourself: “If this person needs the toilet in ten minutes, how will they get help and move safely?” Use the answer to test whether the care plan is practical. Good prevention is visible in the next assisted transfer, not only in the completed paperwork.
Sources and further reading
Prepared for Mini Nurses · 20 October 2026. Mrs Amina’s case and the dialogue are fictional teaching examples. Photographs illustrate people, spaces and equipment; they are not demonstrations of a complete falls prevention protocol or endorsements of products.
- NICE NG249: Falls — assessment and prevention in older people and people 50 and over at higher risk (2025).
- AHRQ: Fall TIPS, a patient-centred fall prevention toolkit.
- Royal College of Physicians: Comprehensive falls assessment for inpatients.
- AHRQ: Preventing Falls in Hospitals — toolkit, including bedside precautions and post-fall review.
- CDC STEADI: Postural hypotension.
- CDC STEADI-Rx: Medication-related falls risk.
- MHRA: Bed rails — management and safe use.
- NHS Ayrshire & Arran: Essential care immediately after an inpatient fall.
Use current local protocols for clinical assessment, mobilisation, lifting and emergency care. Each photograph has its source and reuse licence in its caption.