The “5 P’s” is a standardized, proactive strategy used by healthcare providers, often called “rounding,” to conduct routine patient checks. This mnemonic anticipates and addresses the most frequent reasons a patient might attempt to move or get out of bed without assistance, which is the primary cause of hospital falls. By systematically checking these five areas, caregivers significantly reduce the environmental and personal risks contributing to patient falls. These proactive assessments are generally performed on a scheduled basis, such as every hour or two, to ensure patient needs are met before they prompt unsafe movement.
Pain Assessment and Management
The first “P” addresses Pain, recognizing that discomfort is a major driver of unassisted patient movement. A patient experiencing uncontrolled pain may try to shift position abruptly or attempt to get out of bed to find a nurse or medication, all of which increase fall risk. Chronic pain can also alter sensory perception and decrease muscle strength, impairing balance and stability.
Managing pain effectively stabilizes the patient and minimizes the impulse for sudden actions. This management involves pharmacological interventions, such as adjusting analgesic dosages, and non-pharmacological methods like repositioning or using heat and cold packs. Caregivers must carefully balance treatment, as some pain medications, particularly opioids, can cause side effects like dizziness and drowsiness, which itself increases fall risk.
Positioning and Comfort
The second “P” focuses on Positioning, ensuring the patient is situated safely and comfortably within their immediate environment. This involves physically adjusting the patient in the bed or chair to relieve pressure and prevent the urge to frequently adjust themselves. The bed should always be kept in the lowest possible position, and the wheels must be securely locked.
A fundamental part of safe positioning is ensuring the call light is immediately accessible, typically clipped to the patient’s gown or bedding. Making it easy to call for help prevents the patient from straining to reach a distant cord. Providing supportive devices, such as pillows or wedges, further encourages the patient to remain safely situated while minimizing discomfort.
Potty and Toileting Needs
The third “P,” Potty, addresses elimination needs, which are statistically one of the most common reasons patients attempt to move without assistance. The desire to use the bathroom often creates a sense of urgency that overrides a patient’s awareness of their physical limitations, prompting them to move quickly and unsafely.
Proactive toileting involves asking the patient directly about their needs and implementing a scheduled toileting routine. This regular schedule helps manage incontinence or urgency. The use of bedside commodes, urinals, or planned assisted transfers to the bathroom removes the primary trigger for leaving the safe confines of the bed or chair.
Personal Possessions and Environment Checks
The fourth “P” is Personal Possessions, involving a safety check of the immediate patient environment and the accessibility of their belongings. Ensuring that essential items are within easy reach prevents the patient from stretching, leaning, or climbing out of bed to retrieve them.
Items like eyeglasses, the telephone, the water pitcher, and the television remote should be placed on a bedside table within the patient’s safe zone. The environment must also be clear of potential hazards, including clearing clutter and ensuring adequate lighting. Electrical cords should be secured near the wall, eliminating trip hazards.
Pumps, Lines, and Equipment Safety
The final “P” focuses on Pumps and Equipment, recognizing that medical devices can pose physical hazards. Patients are often connected to various equipment, including IV poles, feeding pumps, and wound drains. These lines and wires frequently become tripping hazards if they are not properly managed and secured.
Caregivers must ensure that all medical equipment is positioned next to the patient, away from the path of movement. All tubing and electrical cords must be secured off the floor. The functionality and settings of infusion pumps must also be checked regularly, as an alarmed pump can cause a patient to react suddenly and unsafely.