Falls Prevention and Management

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1 Falls Prevention and Management Best Practices Initiative Ministry of Health and Long-Term Care Presentation Prepared By: Hazelynn Kinney Regional Best Practice Coordinator - Central East Region Based on the Toronto Best Practice Implementation Steering Committee s Policy and Procedure Falls Prevention and Management (2006). February

2 Overview Definition of falls Falls Assessment Preventative approaches Strategies and interventions for falls Monitor and evaluate resident outcome Roles and Responsibilities 2

3 Definition of a Fall A fall: sudden, uncontrolled, unintentional, downward displacement of the body to the ground or other object. Note: excludes falls resulting from violent blows or other purposeful actions 3

4 Near fall A near fall sudden loss of balance does not result in a fall or other injury can include a person who slips, stumbles or trips but is able to regain control prior to falling. 4

5 Un-witnessed fall An un-witnessed fall when a resident is found on the floor neither the resident nor anyone else knows how he or she got there. 5

6 Consequences of Falls Fractures of the hip, femur, humerus, wrist and rib, Soft tissue injuries, Hematoma, Transient confusion, 6

7 Consequences of Falls Social/psychological consequences, Sometimes sudden aging, Hospitalization and immobilization, Disability, Death 7

8 Predisposing Factors for Falls Secondary diagnosis (especially cardiovascular disease) Advancing age Recent admission History of falls Changes in mental status Transferring activities or the use of assistive devices 8

9 Fall Risk Assessment Conduct the Morse Fall Risk Assessment, Within 24 hours of admission. Any sudden change of status. With quarterly documentation. Complete assessments including cognitive status, e.g., Mini-Mental Status Examination (MMSE). Document and update quarterly. 9

10 Morse Fall Scale Determine Fall Risk Factors Determine Morse Fall Score High Risk 45 and higher Moderate Risk Low Risk 0-24 Target Interventions to Reduce Risks Note: Complete checklist for resident assessed based on level of risk 10

11 Fall Risk Interventions Develop interventions address residents identified as at risk for falling implement plan of care based on level of risk Initiate a written plan of care within 24 hours of admission update as necessary. 11

12 Falls Risk Evaluation Evaluate and document resident outcome. 12

13 Interventions/Strategies to Reduce Risks for Falls Familiarize the new resident with the surroundings on admission. Assign the resident to a bed that enables the resident to exit towards his/her stronger side whenever possible. 13

14 Provide education Teach resident proper ambulation and use of assistive devices: do not turn on the heel of the foot; use handrails; wheelchair safety (brakes, pedals); and do not pull down on walkers when rising to a standing position. 14

15 Provide education Teach resident to sit on the edge of the bed for several minutes before rising. Caution resident to avoid bending his/her head sharply backwards. Instruct resident to refrain from working with his/her arm above their head. 15

16 Provide education Instruct resident and family members about appropriate footwear: use of treaded socks and/or non-skid footwear. Instruct the resident to request assistance with ambulation. repeat instructions to call for help on each shift 16

17 Exercise Assess the resident s coordination and balance before assisting with transfer and mobility activities. Engage the resident in physical activities and exercise. 17

18 Medication Review Conduct periodic medication reviews such as: dosage, side effects and interactions with food or other medications. Examine medication dosing schedules. 18

19 Medication Review Note: Residents taking: benzodiazepines, tricyclic antidepressants, selective serotonin-reuptake inhibitors, trazodone, or more than 5 medications should be identified as high risk. Residents on anticoagulants should be monitored after a fall for possible hematoma. 19

20 Nutrition, Vitamins and Supplements Provide information on the: benefits of Vitamin D supplementation in relation to reducing fall risk. dietary, lifestyle, and treatment choice for the prevention of osteoporosis to reduce risk of fracture. 20

21 Hip Protectors/Helmet Consider the use of hip protectors/helmet to reduce fractures. 21

22 Environmental Considerations Place an at risk indicator on the chart and on the bulletin board above the bed. Perform environmental rounds to promote safe environment. 22

23 Continence Management Assess the resident for a bowel and bladder program to decrease urgency and incontinence. Assist with toileting as needed and record signs for possible urinary tract infection or constipation. 23

24 Some Alternative Strategies to Restraints Individualizing daily routine such as sleep patterns; activity patterns; toileting programs. Bedside commode. Monitoring devices (e.g., bed alarms). Use night light assists with orientation and prevents unsafe transfers at night. 24

25 Post Fall Management Initiate Head Injury Routine assess resident s level of consciousness any potential injury associated with the fall. Notify the attending Physician Ensure immediate treatment after the fall. Complete incident report and detailed progress note. Investigate the contributing factors associated with the fall including location, time and related activity. 25

26 Post Fall Management Review fall prevention interventions and modify plan of care as indicated. Communicate to all shifts that resident has fallen and is at risk to fall. Monitor the resident for 48 hours after a fall if they are on anticoagulants such as heparin, coumadin and aspirin. 26

27 Roles and Responsibilities of Registered Staff Fall-risk assessment Initiates plan of care Referral to interdisciplinary team members. Ensures procedures for high fallrisk residents are in use. Provides education to family/resident about falls prevention strategies. Evaluates the plan of care. 27

28 Roles and Responsibilities of Health Care Aide/Personal Support Worker Follows procedure and care plan for high fall-risk admissions. Monitors residents. Assists residents when transferring, ambulating or walking. Recognizes and reports resident verbalizations and behaviours indicative of discomfort which may potentially lead to falls. Reports any risk factors identified. 28

29 Roles and Responsibilities of Maintenance/Housekeeping Supports a safe environment of care, e.g., preventative maintenance, environmental checks. 29

30 References Queensland Health. (2003). Falls Prevention: Best Practice Guidelines for Public Hospitals and State Government Residential Aged Care Facilities. Queensland, Australia: Queensland Government. [On-line]. Available: Registered Nurses Association of Ontario. (2005). Prevention of Falls and Fall Injuries in the Older Adult. (Revised). Toronto, Canada: Registered Nurses Association of Ontario. [On-line]. Available: Toronto Best Practice Implementation Steering Committee s policy and procedure Falls Prevention and Management Tideiksarr, R. (1989). Geriatric falls: Assessing the cause, preventing recurrence. Geriatrics, 44(7), VA National Center for Patient Safety. Fall Prevention and Management Program. [On-line]. Available: 30

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