STARES 1

STARES 1

Situation
A 79 year old male was admitted for a non-infective exacerbation of COPD. He lives with his daughter and son in law but is fairly independent. His daughter helps with some activities of daily living (ADLs). He has no history of dementia and has been managing well at home. He was not on oxygen and had been ambulating to the toilet by himself. His main complaint was shortness of breath (SOB). Upon being admitted to hospital he became confused and delirious. His notes mentioned he was unsteady on his feet.

Task
My task was to safely ambulate this patient and to assess his oxygen saturation over a longer distance (further than he had been walking by himself).

Action
I started by checking that the environment was clear and safe, and made sure there was a chair by the door in case he needed a rest. I asked him to put his shoes on as he was only wearing socks which could have slipped on the floor. The patient was very impulsive and kept trying to stand up and walk without shoes or a frame. I made sure his frame was right in front of him and reminded him to use it. I also asked my supervisor to stand on the other side of the patient for safety reasons. I monitored his oxygen and heart rate as he walked and kept my commands short and simple (for example “slow down” and “stop”).

Results
The patient ambulated to the doorway of his room and back to his bed, which was approximately 20 metres. He was stopped because I felt it was unsafe. He was unsteady on his feet and particularly unsafe when turning. He liked to walk very quickly at an unsafe speed. This patient did not realize how unsafe he actually was.

Evaluation
I think I made the right decision to stop this patient after 20 metres. Although we could not assess his oxygen over a distance (our initial aim) I believe it would have been unsafe to continue. By stopping him early in the walk I may have prevented a fall, which may have injured the patient or myself. Weighing up the pros and cons of the decision I think the right one was made.

Strategies
There are several strategies that can be employed to prevent falls when ambulating a patient:
1. Be aware of their medical history and current status – i.e. if they are confused, have dementia, are delirious.
2. Clear the environment of where you are planning to walk.
3. Make sure you have a second person if the person seems unsteady or unsafe.
4. Stop straight away if they are not safe, it’s not worth the risk.