Patient safety, falls and pressure injury DHA exam: risk tools, prevention and what to do next

Patient safety, falls and pressure injury for the DHA exam: the shape of the topic

Sources report patient safety as a core content area for nurses, and falls and pressure injury are classic examples. We could not confirm how many questions each carries. Exams like these topics because the right answer is nearly always the earlier, simpler action.

Meddex is independent and is not connected to the Dubai Health Authority (DHA) or Prometric.

This is exam-preparation revision, not clinical guidance. In practice, follow your own organisation’s policies and the current guideline, and check doses and thresholds against them.

Safety starts with identification

Use two identifiers, such as full name and date of birth, before any medicine, blood product, test or procedure. A room number or bed number is not an identifier. Treat the wristband as the source, and ask the patient to state their name where they can. For handover, use SBAR.

Falls: assess, then act on the result

Risk tools such as the Morse Fall Scale score factors including history of falling, a second diagnosis, walking aid, intravenous therapy, gait and mental state. Cut-off scores differ between hospitals, so questions normally give the score and the band. Reassess when the patient’s condition changes.

• Keep the call bell, glasses and walking aid within reach.
• Keep the bed low and the brakes on, and the floor dry and clear.
• Offer regular toileting, since many falls happen on the way to the toilet.
• Review medicines that cause drowsiness or low blood pressure.
• Use non-slip footwear and supervise walking.

After a fall

Stay with the patient and call for help. Do not move them until you have checked for pain, injury and the head, neck and spine. Check vital signs and conscious level. Start neurological observations if the head was hit or the fall was not seen, especially if the patient takes blood-thinning medicine. Tell the doctor, document the facts, complete the incident report and review the care plan to stop it happening again.

Pressure injury: risk and prevention

The Braden Scale is a common risk tool, and a lower score means higher risk. Prevention follows the same steps in most guidelines: inspect the skin, change position on a schedule set by the care plan, keep the skin clean and dry, use pressure-relieving surfaces, lift heels off the bed, support nutrition and fluids and avoid dragging the patient across sheets. Do not massage red skin over a bony area.

Pressure injury stages

The staging system from the National Pressure Ulcer Advisory Panel, now the National Pressure Injury Advisory Panel, uses Arabic numerals:

• Stage 1: intact skin with redness that does not blanch.
• Stage 2: partial-thickness loss with exposed dermis, or a blister.
• Stage 3: full-thickness skin loss with fat visible.
• Stage 4: full-thickness loss with muscle, tendon, ligament, cartilage or bone exposed.
• Unstageable: depth hidden by slough or eschar.
• Deep tissue injury: persistent deep red, maroon or purple area.

Example: a red heel

Example, written by Meddex. A nurse finds a red patch on a patient’s heel that stays red when pressed, with the skin unbroken. The best action is to relieve pressure by lifting the heel off the bed, document the finding as a stage 1 injury, update the care plan and inform the team. Rubbing the area or leaving it for the next shift are wrong. The prioritisation guide explains why early action wins.

Reporting and a safety culture

Report errors and near misses through the incident system. Blame is not an answer in an exam, and learning is. Related medication safety questions use the same logic.

Restraints, bed rails and other safety choices

Restraints are a last resort. Try other measures first, such as sitting with the patient, reducing noise, treating pain, checking the toilet and using a sensor alarm if your unit allows. If a restraint is used, it must follow law and policy, with an order, regular checks of skin and circulation and a plan to remove it. Bed rails can trap a patient and can count as a restraint, so use them only as your policy states.

You may also meet this topic as nursing patient safety questions, fall prevention in nursing, pressure ulcer prevention or pressure sore staging. Use the same order each time: assess the risk, act on it, check the result and record it.

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