Lessons Learned

Rolling Stools

Stools are a common source of falls for patients, visitors and staff. These chairs are not meant for long-term seating and are primarily used by staff. However, when left unattended, patients or their visitors will seek the vacant seat to rest or relax if all others are occupied. According to the Agency for Healthcare Research and Quality (AHRQ), between 700,000 and 1,000,000 people in the nation fall in hospitals each year. Stool falls reported in the CHPSO database were all unassisted and often led to visits to the ED for fractures or lacerations.

This is a sampling of the cases in the CHPSO database involving stool-related falls:

  • Father of infant fell with infant in his arms while trying to sit on a rolling stool. Infant unharmed.
  • Patient woke up to void in urinal at bedside and leaned forward to brace himself on doctor’s wheeled stool. Stool slid from underneath him and he slid on the floor. He scraped his shoulder on the bedside rail. Subsequently, doctor’s stools were removed from all patient areas.
  • Patient’s family member was on a cell phone call in the hallway and sat down on a wheeled stool that was meant for staff. He got up from the stool and fell forward landing on his knee with both upper extremities outstretched to support his upper body from falling; his right leg was stretched out from under his body.
  • Patient was sitting down and misunderstood nurse’s order not to get up. The patient stood up and attempted to sit back down on the wheeled stool. The patient leaned back against the stool and slid backwards; she fell on her right side. X-rays were taken.
  • Patient was sitting on a wheeled stool by the nurse’s station while eating. She moved and fell on her knees. Patient was examined in the ED; no injuries were sustained.
  • Patient’s spouse was attempting to sit on wheeled stool and the stool rolled away from her, falling to the floor. Patient had a small amount of lower back pain and was sent to the ED.
  • Patient attempted to sit on wheeled stool and the stool rolled away. The patient fell on his left side. The patient used to lean on the wall and hold onto the handle bar to rest but this time the patient wanted to sit on the stool found in the hallway.
  • Nurse was sitting on a stool at the bedside. The nurse finished bandaging the patient and suddenly the solder joint broke, separating the round seat from the wheeled base of the stool leaving a sharp edge. The nurse landed on the floor. Others quickly came to investigate due to the loud noise as the nurse also knocked a bottle of sterile water off of a stand. Engineering was notified who stated that they would dispose of the stool as it was irreparable.
  • Patient was instructed to stay in wheelchair but ignored instructions and tried to sit on wheeled stool used by physicians. Patient fell, incurring a small laceration on the right elbow.
  • Tech performed study for bilateral hand and knee films. Tech sat the patient down on an exam stool with wheels to get the patient to the exam table to perform the bilateral hand study. When the tech was walking to the workstation to get set up for the study, the tech heard the stool wheels move but did not hear or see the patient fall off of the stool. Patient complained of lower back pain. Nurse assessed patient who was transferred to the ED via wheelchair.

Suggestions for purchasing stools

There are ways to prevent falls from occurring at your organization when wheeled stools are involved:

  1. Avoid stools with casters if at all possible or purchase stools with safety brakes on the casters.
  2. Avoid three-legged stools for stability.
  3. Stools with padded armrests provide more comfort and support, especially if spending a lot of time sitting on the stool.
  4. If wheeled stools are necessary, CHPSO suggests keeping stools away from patients and labeling them so patients do not use them.

Given that stool falls commonly occur when unassisted, prevention efforts can be made by increasing staff assistance and awareness in the units. It is important to target the prevention efforts to patients or visitors who may be at risk, such as the elderly and infants being carried by visitors. Falls from stools can cause serious injuries and the entire clinical staff should work together to prevent them.

References:

Preventing Falls in Hospitals. Agency for Healthcare Research and Quality, Rockville, MD.

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