Found on the floor after a fall on the ward
RCSI OSCE practice station

The task

You are the nurse on an orthopaedic ward. Mr Tom Gallagher, aged 79, is two days after a wrist operation and was found sitting on the bathroom floor by a healthcare assistant, who is with him. Introduce yourself, confirm his identity and assess him safely before moving him. Take and record observations, assess neurological status and for injury, decide whether to escalate and telephone the doctor using ISBAR. Record your assessment and the plan, including how you would address his risk of falling again.

What this station tests

• Assess before you move; do not stand a patient with possible injury.
• Head injury plus anticoagulant is an urgent escalation.
• Do neurological observations at the intervals the doctor sets, such as every 15 minutes.
• Use ISBAR and read the plan back.
• Complete an incident report, tell the family and put a falls prevention plan in place.

Sources for the clinical content

• HSE: prevention and management of falls workbook for clinicians
• National Clinical Guideline No. 1: INEWS V2 summary, including the scoring key
• HSE: ISBAR communication tool
• NMBI: Code of Professional Conduct and Ethics
• RCSI: overseas aptitude test preparation (public topic list)

An original practice scenario with invented patients. Not an exam question.

Practise next

• Pressure area check for a frail older woman