The Fall Prevention Center of Excellence is supported by the Archstone Foundation

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Godfrey Strickland
8 years ago
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1 FllPr Fall Prevention: n Translating Knowledge Into Action 2009 ASA/NCOA Joint Conference Workshop March 18, Las Vegas, NV

2 Addressing Falls in Facility-Based Communities Steven C. Castle, M.D. Professor of Geriatrics, UCLA Chief, Geriatric Medicine, VA Greater LA Corporate Medical Director, SCPH hpp

3 Addressing Falls Mather LifeWays Survey of CCRC s, paramount concern that falls reduction be a priority area to senior wellness Indep Living lowest fall rate in CCRC, BUT: 50% of IL suffer some injury vs. 11% in ASL/SNF 30% who fall in IL need medical attention Only 40% of ILC s have Protocols, if did then; 60% -standardized tool (50% were self-developed) Med assessment in only 37%

lowest fall rate in CCRC, BUT: 50% of IL suffer some injury vs.

4 Goal: Facility-Based Communities Current Strategy at SCPH s Standardized practices/processes Process mapping, review forms Identify best practices, areas of improvement Data Gap Analysis: who touches it, uses it Establish Processes that synthesize data to support day-to-day decisions, prospectively show that you are making a difference Assessment of Chronic Illness Care support for Chronic Care Model; effective QI

uses it Establish Processes that synthesize data to support day-to-day decisions, prospectively show

5 Strategy Depends on Level of Care to be Targeted Residential/Independent d d t Living i High Functioning residents into High Level Balance exercises? Address nonspecific, treatable medical conditions Transitions-residents need higher level Won t ask for help, but need it Don t recognize risk of poor balance Skilled: Highest risk for injury Dementia (Mild to Mod vs Mod to Severe)

Address nonspecific, treatable medical conditions Transitions-residents need higher level Won t

6 Model-based Programs Residential: Wellness Model Bandura model of self-efficacy Transitions: i Resident Self-Selection Sl with ihcoaching Don t recognize risk vs. don t ask for help What assessments needed/ d/ process to support Barriers to getting therapy, response Skilled: Chronic Care Model Interdisciplinary Team: performance on bad outcomes; train, monitor improvement

don t ask for help What assessments needed/ d/ process to support Barriers to getting

7 Effective care does not happen By chance or simply by, Working harder. Edward H. Wagner: Medical Care 2004; 42:1037-9

8 Balance & Mobility Fitness Awareness Campaign: Royal Oaks Manor, SCPH Resident Council Involvement: Safety Captains Slogan & Logo Newsletter Wellness Screening Campus visibility: Dr Balance Wellness Lectures Brown Bag Event: meds & falls Exercise interventions some free, some $ Training for staff IDT at the nursing station

Campus visibility: Dr Balance Wellness Lectures Brown Bag Event: meds & falls

9 22 residents identified as high risk by staff; screened to facilitate participation in exercise Screening / testing Sens Initial Screen 95% 8 ft Up & Go 91% Berg Balance Scale 50% Postural Hypotension Found 27% Low vision Found 9% Screening by Questionnaire >2 falls in past year 32% Fear of Falling 23% Hi Risk Dx 23% Episodes of dizziness 9% Injury from fall in past year 5%

Postural Hypotension Found 27% Low vision Found 9% Screening by Questionnaire >2 falls in

10 RESULTS: High sensitivity (95%) 8ft Up & Go alone (91%) Screening gq questions (all 73%, any one <33%) Berg Scale helped triage to exercise program Initial increase in exercise interventions- In context of a wellness program Filled 3 balance classes, 2 tai chi-based classes, previously <1 class Provided Efficacy information via performance experience Difficult to sustain

interventions- In context of a wellness program Filled 3 balance classes, 2 tai chi-based

11 Attitudes on B/M/F at ROM, Oct 2008, n=58 Importance of B/M/F 1 low, 5 hi Older adults fall, little can be done, 1 disagree, 5 agree Chance of losing balance, 1 low, 5 high

done, 1 disagree, 5 agree 5 4.5 4 3.5 3 2.5 2 1.

12 % Responding Ye es % Participating in Programs by Perceived Balance Category Low chance of falling, n=8 2, n=11 Medium chance, n=23 4, n=8 High Chance, n=6

13 Resident Residential Care coordinator Consultant Pharmacist Doctor Therapy & Exercise Admin Process Map: Regents Point, SCPH admission Resident Education Alcohol Sweep Level of care change? assisted living or Skilled compare data: adm sheet Reps care MMSE resident awareness IDT Plan of care Pharmacy Review of hi risk Meds Admission Packet Therapy assistive device Safety & mobility Assistive Device Use 1:1 PT or OT Assistive device training Better Balance Basice balance data Hi INR Postural BP drop Resident fall risk Rec Med adjustment Balance & Mobility Assessment Med changes Fall Event Post Fall assessment Med Review Home eval ADL assistance Alcohol Sweep Check on resident Med adjustment rec d B&M ass ment Rx Non specific medical issues med adj Therapy Cognitive ass ment Therapy reassessment: Therapy plan Home health On site, other Cognitive ass ment, ADL assistance Env mod level ov care Priv duty nurse IDT Plan of Care Monitor response to med adjustment Sleep, toileting New Findings cogn decline Monitor response to therapy resident safety Level of Care Change falls Data monitored

Assistive Device Use 1:1 PT or OT Assistive device training Better Balance Basice balance data Hi INR Postural BP drop Resident fall risk Rec Med adjustment Balance & Mobility Assessment Med changes

14 System Redesign: Logic Model RESIDENT DOCTOR FAMILY Screening, assessment Collaborative Strategies Outcome/ F/U BMF Mentors Continuity/follow up Database entry/reports Communication Support IDT Review Training/Credentialing Audit Documentation THERAPY & EXERCISE PHARMACY Balance AWARENESS RISK MANAGEMENT TRAINING FALL EVENTS G-H Database NURSING ASSESSMENT SCastle PROTOCOLS 2008 HANDOFF DOCUMENTATION actual CARE PLAN

Training/Credentialing Audit Documentation THERAPY & EXERCISE PHARMACY Balance AWARENESS RISK MANAGEMENT

15 1. Raise community awareness Lecture, newsletters, health fairs Brown bag med review Resident council/ Safety Captains Measure Resident Satisfaction 3. Facility self management Standardized screening Programs that promote Awareness/efficacy Recognize cognitive decline 2. Standard facility-based medical management Med adherence review Treatable nonspecific conditions Monitoring of protective elements Full spectrum of exercise/therapy (dementia) 6. Monitor fall rates Prospective Functional Impact Data to Generate BMF Profile Training- Who, when 4. BMF Mentors Prompt MD ass ment/mgt t 5. Post fall assessment/huddle Med review, delirium/dementia Cause of poor balance, med effects Response to therapy/nursing programs Communication- MD/Pharm/Therapy Prospective risk mgt- adjust plan

Standard facility-based medical management Med adherence review Treatable nonspecific conditions Monitoring of protective elements Full spectrum of exercise/therapy (dementia) 6.

Falls Risk Assessment. VNAA Best Practice for Home Health

Falls Risk Assessment. VNAA Best Practice for Home Health Falls Risk Assessment VNAA Best Practice for Home Health Learning objectives The participant will be able to: Identify two reasons to implement a falls risk program Identify three risk factors for patients