Fall Prevention in Home Health

Transcription

1 Fall Prevention in Home Health Fall Prevention and the Home Healthcare Client AIG Healthcare is a division of the property-casualty insurance subsidiaries of American International Group, Inc. AIG Consultants (AIGC) is a member company of American International Group, Inc. The information and tools contained in this document are provided as a resource to improve or supplement a home healthcare agency s current risk management procedures, forms and staff education programs. They are not meant for adoption as is, but to serve as a model to design, or improve upon, existing procedures, forms and staff education. Suggestions contained in this document have been developed from sources believed to be reliable. However, the accuracy and correctness of such materials and information has not been verified. AIG Consultants makes no representations or warranties, either express or implied, nor accept any legal responsibility for the correctness or completeness of this material or its application to specific regulations. This information should not be construed as business, risk management, or legal advice or legal opinion. Reliance upon anything contained herein shall also be at your own risk.

2 Page 2 of 18 Program Objectives Describe components of a fall prevention program Present most common factors that contribute to falls in the home Describe methods and strategies to prevent falls in the home Present strategies to educate patient/family on ways to prevent falls and subsequent injuries

3 Page 3 of 18 Fall Definition A fall is defined as: An unintended event in which a home care patient comes to rest unintentionally on the ground or other lower level 7 Preventing a fall is challenging, as home care staff are not present with patient around-the-clock Many falls in the home are not observed

4 Page 4 of 18 Fall Prevalence and Statistics Nearly 1/3 of adults 65+ in U.S. fall each year 1,2 85% of falls occur in home 3 Falls are a leading cause of injury deaths among adults 65+ Falls are most common cause of nonfatal injuries and hospital admissions for trauma 4 Falls cause 90% of hip fractures 5 and 20% die within a year of their injury 6 Total direct cost for falls among older adults in 2000 was about $19 billion 7 Falls are a leading cause of emergency department visits among children 8

5 Page 5 of 18 Components of a Fall Prevention Program Conduct an initial fall risk assessment Determine patient s level of fall risk Develop patient-specific fall prevention strategies Educate patient/family about how to implement fall prevention strategies Communicate patient s fall risk and fall prevention plan of care to others Reassess patient s fall risk and update plan of care ongoing

6 Determining Patient s Fall Risk: Intrinsic Risk Factors Personal Risk Factors Advanced age 65+ History of previous fall(s) Physical Conditions Balance and gait Musculoskeletal system Mental status Vision Page 6 of 18

7 Page 7 of 18 Determining Patient s Fall Risk: Intrinsic Risk Factors, continued Acute Medical Conditions Low blood pressure/orthostatic hypotension Stroke Seizure Chronic Medical Conditions Parkinson's disease Cataracts or glaucoma Arthritis Heart rhythm abnormalities Meniere's disease Alzheimer s disease/dementia Diabetes or epilepsy Brain disorders Osteoporosis

8 Page 8 of 18 Determining Patient s Fall Risk: Extrinsic Risk Factors Home Environment Condition of ground surfaces Design of furnishings Bathtubs and toilets Illumination conditions Medications Polypharmacy Drug-drug interactions and side effects Affects the central nervous system Can cause urgency in elimination Can cause postural hypotension Treatment supplies

9 Page 9 of 18 Determining Patient s Fall Risk: Extrinsic Risk Factors, continued Type and Condition of Footwear Improperly-fitting shoes from edema or other foot problems Incompatible soles Assistive Devices Improper use of device Canes Walkers Wheelchairs

10 Page 10 of 18 Fall Risk Assessment Activities Review patient s demographics, diagnoses and history of falls Review all medications, including home remedies Assess patient s cardiovascular status, hydration, heart rate, rhythm and blood pressure for cardiac arrhythmias and orthostatic hypotension Observe home environment for unsafe conditions Confirm patient s proper use of ambulatory aide Perform timed Up and Go test 9

11 Page 11 of 18 Fall Prevention Strategies Cognitive/Memory Problems Consider bed/chair alarms to alert family when patient is attempting to transfer on own Check frequently on patient Place mobility aids directly next to patient s bed on side that patient exits Instruct patient to use mobility aid frequently Instruct patient not to get up without help Minimize distractions Reinforce activity limits and safety precautions Consider use of sitters

12 Page 12 of 18 Fall Prevention Strategies CVA Transfer patient toward stronger side Approach patient toward unaffected side to maximize participation in care Incontinence, Nocturia or Urgency Implement bowel and bladder programs to decrease urgency and incontinence Consider obtaining an order for medication to reduce urgency Place urinal or commode at bedside Orthostatic Hypotension Instruct patient to rise slowly from bed to prevent fainting Monitor cardiovascular status, heart rate, rhythm and blood pressure Encourage adequate hydration and nutrition

13 Page 13 of 18 Fall Prevention Strategies Gait/Mobility Problems/Weakness/Neuropathy Request that physical therapist (PT) or occupational therapist (OT) assess patient Implement PT and OT recommendations Approach and transfer patient to stronger side Consider use of a helmet to reduce head injuries (i.e., patients on anticoagulants, severe seizure disorder, etc.) Place patient care articles within reach Instruct patient to wear nonskid footwear Fear of Falling Consult PT or OT for strength and balance training History of Fractures/Osteoporosis Encourage weight bearing exercises Encourage use of hip protectors

14 Page 14 of 18 Fall Prevention Strategies Environmental Place assistive devices on exit side of bed and frequently used items within reach Remove clutter, tripping hazards, spills etc. Place hospital bed in the low or very low position Use chair that is sturdy and easy to get out of Place rest stops in hallways Use night light that goes on automatically at dusk Assure room is well lit Place slip resistant strips in tub and grab bars in shower Adapt toilet seat to a height that allows easy transfer or install transfer bars Install a shower stool so the patient may sit while showering

15 Page 15 of 18 Fall Prevention Strategies Medication Provide instruction in medication time/dose, side effects and interactions with food or other medications/supplements Caution patient against use of alcohol Coordination with Family Include patient/family in development of an individualized home safety and fall prevention plan Encourage patient s family to provide assistance, while maintaining patient s independent functioning Recommend a sitter/companion to provide one-to-one observation with patient and to maintain a safe environment

16 Page 16 of 18 Fall Prevention Strategies: Working as a Team Communicate fall risk status and risk factors with others involved in patient s care Review medications with physician for possible modification/discontinuation Obtain orders for PT or OT to: - Evaluate patient s gait and balance - Evaluate strength and function of lower extremities - Review use of/need for an assistive device - Assist with ADL management - Provide gait training and strength training - Establish home exercise program with balance training Obtain orders for a social worker (MSW) to provide extra support Obtain orders for a home health aide

17 Page 17 of 18 Evaluate Fall Prevention Program Collect data on patient falls - Observed versus unobserved falls Analyze data and determine reasons for falls Could fall have been prevented? Observe for adverse patterns and trends Develop targeted action plan to reduce fall incidence Monitor effectiveness of fall prevention program on an ongoing basis

18 Page 18 of 18 Sources: 1. Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. (1994). Preventing falls among community-dwelling older persons: Results from a randomized trial. The Gerontologist. 34(1): Hausdorff JM, Rios DA, Edelber HK. (2001). Gait variability and fall risk in community-living older adults: A one-year prospective study. Archives of Physical Medicine and Rehabilitation. 82(8): Abreu N, Hutchins J, Matson J, Polizzi N, Seymour CJ. (1998). Effect of group versus home visit safety education and prevention strategies for falling in community-dwelling elderly persons. Home Health Care Management and Practice, 10(4), Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2006) [cited 2007 Jan 15]. Available from URL: 5. Carter ND, Kannus P, Khan KM. (2001). Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence. Sports Medicine. 31(6): Toteson ANA, Gabriel SE, Ransom JE, Melton JL III. (2002). Mortality, disability, and nursing home use for persons with and without hip fracture: A population-based study. Journal of the American Geriatrics Society. 50: Centers for Disease Control and Prevention (CDC). Preventing Falls Among Older Adults. December, Centers for Disease Control and Prevention (CDC). National Center for Injury Prevention and Control. Preventing Injuries at Home and in the Community. Accessed on December 6, Podsiadlo D, Richardson, S. (1991).The timed "Up & Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 67: