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Proper Grab Bar Placement in Bathrooms Reduces Falls

Colleagues,

I am delighted to launch this first informational message to you on behalf of Curbell Medical, Inc., designed to provide you with fall and fall injury prevention resources. The resources that I am sharing with you offer suggestions to create a safer environment, enhance patient/resident interaction within the environment, and redesign nursing workflow – all with our shared goal to reduce fall risk.

For this inaugural message, I am introducing to a little known resource from the Minnesota Hospital Association (MHA):  Creating a Safe Environment to Prevent Toileting-related Falls, located here, a resource from the Minnesota Hospital Association (MHA) SAFE from FALLS program, 2014.  This research report was created as a response to MHA’s recognized need to reduce toileting-related falls.  I encourage you to share and review this resource with your Patient Safety and Fall Prevention Teams. The research team offers creative solutions to promote safe toileting and reduction in falls.

Falls in bathrooms are particularly hazardous due to the close environment and multiple hard and / or sharp surfaces that individuals strike during the descent to the floor. In 2011, CDC published an alarming report of non-fatal bathroom injuries among individuals 15 years of age and greater in the US 2008. This reference is the only one that I have located that quantifies non-fatal falls in bathrooms.  In their analysis, 234,094 non-fatal bathroom injuries were treated in the US EDs, and the injury rates increased with age.

  • 1% of the injuries were due to falls, head or neck was the most common primary part of body injured
  • the highest rates for injuries occurred in or around the tub of shower (65.8 per 100,000), followed by injuries that happened on or near the toilet (22.5 per 100,000).
  • precipitating events in 37.2% of the injuries were bathing, showering or getting out (NOT in) of the tub or shower.

These results support the importance of bathroom safety across all settings to care to reduce fall risks.

Proper Grab Bars is one of the primary strategies to reduce falls associated with mobility in the bathroom. Grab bars are essential for assisted mobility, offering patients support navigating within the bathroom, but also compensating for difficulties to safely lower onto and rise up from the toilet.  Researching grab bars, they address the problem in bathrooms with “inconsistent size, location and use of the grab bars in the toilet room” (p. 8).  Many bathrooms have horizontal and vertical grab bars surrounding the toilet, mounted on the wall, that are too far away from the toilet, as seen in the photos on p. 19. You will also see swinging or drop down grab bars that are too high above a low toilet seat.

The researchers have provided you an entire section, 4.5.6 Grab Bars, p. 67, with best practice recommendations based on research for the placement of grab bars. For the purpose of this message, I will highlight key findings from p. 74, with hopes that I am inspiring you and your team to read further.

  • Install two fold-down grab bars on either side of the toilet, as opposed to the wall-mounted grab bars. Their research found that almost 4 times more falls occurred with wall-mounted grab bars.
  • Older adults prefer double armrest systems for optimal support to using the arms
  • Older adults with balance problems typically use vertical grab bars for stability.

Most hospital, long term care and residential setting have grab bars, horizontal and vertical bars that are too far away from the toilet and the patient’s body. If grab bars are too far from the toilet, the arms are abducted from the body, relying on deltoid muscles for movement. The resulting biomechanics offer insufficient muscle strength for descending and ascending positioning from a toilet.  The recommendations above, to have fold-down grab bars on each side of the toilet, maximizes a patient’s ability to hold onto the grab bar, lower and rise from the toilet, utilizing biceps and triceps.

A temporary solution, while awaiting proper placement of grab bars, is placement of a commode, without the bucket, placed over the toilet.  Nursing staff commonly resort to the solution to maximize patient toileting.  Still, the bedside commode needs to be individually height-adjusted for each patient. So many patients require this modified environment to safely toilet –low back pain, maternity, post-surgical, orthopedic, elderly, and more.

Creating safe environments reduces risk of accidental falls.  All these strategies require interdisciplinary collaboration, planning, implementation and evaluation.

I hope this information is helpful to you. Please contact me if I can be of assistance to you.

Thank you,

Pat

Patricia A. Quigley, PhD, ARNP, CRRN, FAAN, FAANP
Nurse Consultant

 

References:
The Falls Assessment Research Report: Creating a Safe Environment to Prevent Toileting-related Falls, an element of the Minnesota Hospital Association (MHA) SAFE from FALLS program. 2014.

NonFatal Bathroom Injuries Among Persons Aged > 15 years – United States, 2008. CDC Morbidity and Mortality Weekly Report. June 10. 2011. 60(22).

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.