Equipment Issues and Fall Prevention in Residential Care

Transcription

1 Equipment Issues and Fall Prevention in Residential Care Robin Townsend AUA (Physio), Grad Dip (Gerontology), Cert 1V (Workplace Trainer) 1

2 Best Practice Guidelines Include: Mutifactorial & multidisciplinary approach Standard fall prevention strategies throughout facility Assessment / Identification of fall risks Interventions targeted to the individual Safe environment Mobility, strength & balance exercises Exercises that challenge functional standing balance [Accessed 14/5/09] 2

3 Falls Risk Factors Include: Lower limb weakness Impaired sit-to-stand transfer skill stability in standing (Lord 2001, in Hill 2007) Environmental factors Bed and seating heights Equipment 3

4 Sit-to-Stand & Bed/Seating Heights Strong evidence that impaired sit-to-stand is a falls risk factor (Lord 2001, in Hill 2007) Seating heights between 100 & 120% lower leg length facilitate sit-to-stand (Capezuti 2008, Alexander et al 1996;2000) Hips and knees at 90 degrees & feet flat on floor (Australian Commission on Safety and Quality in Healthcare 2008) 4

5 Capezuti et al (2008), Bed and Toilet Height as Potential Environmental Risk Factors STS transfer ability is greatly hampered at seat heights that are at or less than 80% of lower leg length Heights greater than 120% also deter successful STS transfer and create a higher risk for falls Seat height between 100% and 120% of lower leg length is considered optimal (p.51-2) 5

6 Facility Seating Height: cm Flat seat / firm cushioning Chair arms to front of seat Adjustable for very short / very tall 6

7 Modifications TRANSFER HEIGHT Nb Attach raiser to chair FLAT SEAT FOOT SPACE Feet behind knees Facilitates Sit-to-stand BOX Poor foot position - feet in front of knees Maintains backwards slope of seat Poor initial standing balance Poor transfer skills & need for assistance FALLS 7

8 Elevating Chair Use to maintain sit-to-stand & mobility skills Hips higher than knees Less hip & knee extension effort Facilitates sit-to-stand NB: Do NOT raise too high! (Need to maintain leg muscle strength) 8

9 Sit-to-Stand Bed Height Be dt ag Be d ta g up ri g ht lyi ng do wn 1. Starting position 1a - Hips higher than knees 1b - Bed too low knees too high Feet behind knees Able to lean forwards Feet in front of knees Unable to lean well forwards 9

10 2. Push off 2a Push forwards > weight over feet & knees Able to use quads to push up 2b Swivels to bring feet back & to tip weight forwards Difficult to use quads from deep knee flexion Pushes upwards weight behind feet 10

11 3. Completing the stand-up 3a 3b Weight coming forwards over knees & balls of feet Weight behind knees & balls of feet May overbalance backwards or sideways Feet may slide 11

12 Starting Position Push off Stand up 12

13 Walking Frame 2 HANDS ON FRAME - Difficult to lean forwards / pull feet back - Carers assist > weakness & loss of s-t-s - 2 hands on chair arms to push fwds & up OR - 1 hand on chair arm / mattress edge / bedpole to push fwds & up + other hand on frame handle to guide weight fwds 13

14 Walking Frame - Height CORRECT Elbow flexion ~ degrees Upper arm close to trunk TOO LOW Elbow straight /almost straight Stands inside frame OR leans fwds into frame 14

15 TOO HIGH TOO HIGH Elbows too flexed to take weight effectively Frame pushed ahead Poor control of frame 15

16 Walking Frames Sufficient support for a good gait pattern Lift & Carry Rollator Regular servicing - glides / stoppers wear - wheels collect threads Front Wheels - Rubber - difficult to turn on carpet - need to lift frame > fall risk - Plastic - Glide when turning - safer for many in racf Back - Nylon glides / skis slide easily - Rubber stoppers slow down frame & provide more support Rubber Plastic 16

17 4-wh hand-braking Poor balance Poor cognition 3-wh hand-braking Poor balance Poor cognition Gutter frame Most - no brakes only rubber stoppers/4 wheels Good support Sufficient support for good gait pattern Regular servicing: - Brakes / stoppers - Lubricate swivel wheels - Tyre pressures 4-wh push-down braking Many in racf Supports in response to need Tray-mobile walker No brakes Useful for carriers Good walking position (within frame) Very stable Hand-braking 17

18 BED ISSUES: Which guidelines are appropriate TONIGHT? 18

19 T/F AIDS Bedpole Overhead W Frame BED Electric Manual Divan BEDDING Doona Blankets ALARM Yes / No Type? MAT by bed Foam Non-slip Absorbent SIDERAILS Up Down MATTRESS Flat/Concave Firm / Soft HEIGHT Transfer Lowest 19

20 Capezuti et al (2008), Bed and Toilet Height as Potential Environmental Risk Factors Adjustment of bed height is a nursing intervention that can improve STS performance and potentially reduce fall risk. (p.60) A bed placed in its lowest position. may actually contribute to unsafe transfer and falls. (p.61) Those without the ability to transfer or walk may benefit the most from very low height beds. (Capezuti, Talerico, et al, 1999). (p.62) Bed Height Tags Blue tag = transfer height Orange tag = lowest setting 20

21 BED + Surrounds What is this person most likely to do tonight? How can I make this as safe as possible? 21

22 Mats by the bed Foam mat Rollers Challenges balance in standing may > falls Unable to stand? Trip hazard for resident & staff Non-slip, absorbent, washable, large Between bed & commode for UI Safer than hard floor Small mat often in wrong place 22

23 Bed siderails Increase height of fall Need to escape > climbing over rails or around ends Restraint of voluntary movement May increase safety for some Nb: Bed on lowest setting STANDARD 1 The safety and wellbeing of the client is ensured by restraint practices that reflect current knowledge, applicable law, practice guidelines, codes of practice and organisational policies and procedures. (Accessed 20/5/09) 23

24 Mattresses Concave Reduces risk of rolling off bed - may reduce fall risk Difficulty sit-to-stand - may increase fall risk Soft Overlay More difficult to move on bed Pressure-reducing mattresses User may sink into mattress if too soft May increase difficulty sit-to-stand 24

25 Transfer Enablers Overhead or monkey bar Slide under mattress Bolt-on 25

26 BED GUIDE NB: A guide only WHAT is THIS person MOST LIKELY to do? HOW can I make this AS SAFE as POSSIBLE? 1 Able to STAND Able to WALK 2 Able to STAND NOT able to WALK 3 NOT able to STAND NOT able to WALK GOOD mobility LOW fall risk UNSTEADY HIGH fall risk May try to walk Very HIGH fall risk May CLIMB, CRAWL or ROLL TRANSFER height WALKING AID by bed FLAT mattress? BEDPOLE TRANSFER height WALKING AID by bed FLAT mattress? BEDPOLE? ALARM LOWEST height MATTRESS - FLAT easier s-t-s - CONCAVE may reduce risks -? BEDPOLE? ALARM?? Bed side-rails (caution) LOWEST height CONCAVE mattress may reduce risks MAT by bed? ALARM?? Bed side-rails (caution) 26

27 Bathroom Aids Adjust to transfer height for the individual Service regularly Non-slip rubber stoppers Lubricate adjusters Commode by bed Sit in shower Mobile shower chair if poor balance / gait 27

28 Capezuti et al (2008), Bed and Toilet Height as Potential Environmental Risk Factors, Clinical Nursing Research, Vol. 17, No. 1, (2008) [Accessed 13/2/09] Gray-Miceli, DNSc, APRN, FAANP; Elizabeth Capezuti (2005), A Nursing Guide to the Prevention and Management of Falls in Geriatric Patients in Long-term Care Settings [Accessed 20/5/09] Current Perspectives in the Literature on Restraints in Long Term Care from the J.W. Crane Memorial Library myuminfo.umanitoba.ca/documents/727/restraints.pdf [Accessed 20/5/09] 28

29 Clinical judgement employed by informed professionals is best practice in the absence of good-quality published evidence. Australian Commission on Safety and Quality in Healthcare (2008), Preventing falls and harm from falls in older people. Best practice guidelines for Australian hospitals and residential aged care facilities. [Accessed 14/5/09)] 29