Mobility, Safety, and Injury Prevention
Core concepts
Mobility safety centers on fall prevention and safe transfer. Know that most falls occur during toileting, transfers, and ambulation, often related to orthostatic hypotension, medications, footwear, and environmental hazards. Interventions include nonskid footwear, clear pathways, adequate lighting, bed in low position, call light within reach, and frequent toileting rounds. Gait belts are used for transfers when the resident can bear weight; mechanical lifts are required when they cannot. Never lift a resident by the arms or under the axillae.
Restraints and positioning
Restraints require a physician order and are used only as a last resort; they increase the risk of injury, pressure injury, and decline. Repositioning should occur at least every two hours for bedbound residents. Know how to use a walker or cane: cane on the stronger side, walker advanced first, and the resident's weak side supported.
Traps
A frequent trap is choosing to "restrain the resident to prevent falls." The correct approach is to address the cause and use least restrictive measures. Another trap is lifting a resident manually when a lift is indicated. Questions may also test whether you leave a resident unattended on a toilet or in a shower chair - never do so.
Worked example
A resident tries to get up alone and is unsteady. The best action is to stay with the resident, assist to a safe position, and use the call system; the wrong action is to leave to find help. Rule of thumb: never leave an unsteady resident alone - call for help while staying with them.