Reducing Fall Risks Associated With Toileting

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Falls associated with toileting remains one of the top root causes contributing to falls among all adult patients across settings of care. Toilet-related falls occur due to intrinsic risk factors at the patient-level (i.e. impaired gait and balance, muscle weakness, incontinence) and extrinsic risk factors (i.e. toilet height, access to proper grab bars). Universal toileting strategies remain ineffective toileting programs. In this session, rehabilitation nurses will learn strategies to examine current toileting strategies as the opportunity to redesign a population-based approached to scheduled and assisted toileting and create a safer environment for safe toileting.

Meet your instructor

Pat Quigley

Dr. Patricia Quigley, PhD, MPH, APRN, CRRN, FAAN, FAANP, Nurse Consultant, is a retired Associate Director of the VISN 8 Patient Safety Research Center of Inquiry and is both a Clinical Nurse Specialist and a Nurse Practitioner in Rehabilitation. Her contributions to patient safety, nursing, and rehabilitation are evident…

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Chapters & learning objectives

1. Profile the Complexity of Toileting Fall Risk Factors

Falls associated with toileting refer to the activities specific to navigating the physical environment to use the toilet, the physical act of elimination, the environment design of the bathroom, and staffing assistance. These activities are complex and interactive. This chapter introduces an organizational framework that aligns each activity as a contributing fall risk factor that will then be categorized to a specific type of fall.

2. Individualizing Patient’s Toileting Program

Universal approaches to patient toileting programs fail to address the unique toileting needs of each patient. Clinical practice standards require that rehabilitation nurses use clinical judgment to determine each patient’s specific toileting needs and schedule. Rehabilitation nurses will utilize their clinical expertise to maximize each patient’s functional ability to toilet and increase functional independence.

3. Essential Clinical Assessment for Safe Toileting Mobility Demonstration

Safe toileting mobility requires that rehabilitation nurses have the physical assessment skills to evaluate a patient’s ability to manage toileting. These physical assessment skills involve patient handling (i.e., transfers, ambulation, toileting) and activities of daily living tasks (i.e., clothing management, personal hygiene toileting, grooming) that must be assessed for individualized care planning. The rehabilitation nurse must consider each patient’s functional level of dependence/independence (independent, assisted, dependent), weight-bearing status, need for caregiver assistance, and additional fall risk factors (orthostasis, centrally acting medications, diuretics). Rehabilitation nurses will have the opportunity to refresh physical mobility assessment skills into practice as a means to individualize patient care approach and engage the patient/caregiver as a partner in care.

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Pat Quigley