Falls risk

I’m on an ortho inpatient ward at the moment and we had a pt the other day who has had multiple falls in the past month and has fallen a number of times over the year. The pt does not think they are a falls risk because this is the only time they have actually had any injury from falling. The pt was angry with themselves for putting their arm out to try stop the fall and consequently fracturing their wrist (on their dominant UL) than actually seeing the problem in falling. The pt furniture surfs inside their house and only uses their w/s outdoors (which they hold in their dominant hand). The pt was told that they could go home in the afternoon by medical staff as their surgical procedure had gone well but this was before they had had any PT intervention. As you all know we have to say whether or not the pt is safe for discharge from our perspective, whether or not they can ambulate safely and will not be at risk of falling once they return home. From the S/E we established the frequency of the pts falls which were all happening while at home and from what the pt recalls were all falling backwards losing their balance (the pt has limited neck extension due to other PMHx). The pt was not keen to use their w/s in their non-dominant hand but as we wanted to see how they would cope outside of the hospital we needed to see that they could. Our plan was to walk down the corridor with the pt to see how they managed. After a few steps we noticed the pt was not using their w/s correctly and it was definitely too big for them but could not be adjusted, so our supervisor got another w/s for the pt, and one of us stood with the pt while the third person taught the pt the correct technique. With the new stick and technique the pt struggled walking 10m having 2x close SB A and stumbling at least 5times. As the pt’s expectations were that they would return home that afternoon the pt got really upset and was in tears when we told the pt that from our perspective they were not safe and we were going to let the medical team know they were unsafe for discharge and we wanted to refer the pt to a falls clinic and get geri-ortho to r/v the pt.
The pt was crying and trying to state their case that they manage fine at home and will not fall, despite us trying to rationalize the problem with them. Our supervisor was the one giving the bad news but it still made me feel a bit awkward having the pt so upset and I was not looking forward to going to see the pt the following day as we were the ones preventing the pt from going home. It was a situation that could have been avoided if the pt’s expectations where not that they would definitely be going home that day and if it had been explained to the pt by the medical team that she had to be deemed safe ambulating independently by the PT before being discharged.
This situation shows how pt expectations can be falsely raised if all health professionals dealing with the pt don’t take into account all areas that need to be considered before letting the pt know that they are safe to be discharged from hospital. It also shows how important it is to assess the pt’s ambulation before discharge, as the pt could have gone home and had a bad fall if not assessed by PT before discharged.
It was not a nice situation to be in (having the pt crying) but it was a good learning experience which I was happy to have seen dealt with by my supervisor so if I’m ever faced with the same situation again I’ll be prepared and know how to explain what our aims are and why we do not want the pt to return home, instead of just feeling awkward and not knowing how to respond. It was also a situation which reinforced the need to really monitor the pt well when assessing their ambulation and despite their great desire to return home you have to do what is safe and in their best interests even though they may not agree with you.