From Hospital to Home: Fall Prevention in an Acute Care Setting

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1 From Hospital to Home: Fall Prevention in an Acute Care Setting Patricia A. MacCulloch MS, APRN, BC Adult Nurse Practitioner UMass Memorial Dept. of Orthopedics

2 Mission UMass Memorial is committed to improving the health of the people of Central New England through excellence in clinical care, service, teaching and research.

3 Falls are the leading cause of death of seniors

4 1:3 adults 65 yr and older fall each year

5 35% of community dwelling elderly fall each year

6 Fractures are the most serious health consequence of falls

7

8 87% of all fractures among older adults are due to falls

9 Half of older people hospitalized for hip fractures cannot return home

10

11

12 Whether Man

13 Or Woman

14 We Can Make a Difference

15 In Memory of William Grenier

16 Cause of Falls Physical Condition Intrinsic Factors Weakened physical strength Arthritis, knee, hip, or foot pain Low blood pressure Poor vision Acute illness, Stroke, Parkinson's Depression, Dementia, Delirium Incontinence

17 Intrinsic Cause of falls Medications: Recent medication adjustments or changes Side Effects of Anti-depressants, Benzodiazepams, Anti-psychotics, Anti-cholinergic, Beta-blockers, Anti-hypertensive's, Narcotics Geriatric prescribing: Start low, go slow, and finish.

18 Cause of Falls Environmental Extrinsic Factors Wet or slippery floors Poor lighting Clutter Inappropriate footwear Lack of eyewear or hearing aid Ill functioning assistive device Bed is left in high position

19 Fall Risk Assessment Age over 65 years History of previous fall Use of assistive device Dependent with ADL s Acute illness; MI, stroke Infection Delirium Dementia Syncope, orthostatic hypotension Currently taking 9 or more medications Polypharmacy Prescribing cascade Medication changes

20 Fall Risk Modification Treat and manage: Hypotension Metabolic imbalance Infection Dehydration Pain Delirium Gait imbalance Environmental assessment Call light in reach Encourage assistive device (eyewear, hearing aid, hip protectors, walker/cane) Appropriate footwear Floors clean and dry No scatter rugs No clutter

21 Patient care areas Bed controls at fingertips Bed trapeze Bed alarm Bedside commode placed alongside bed (replaces urinal) Non-skid floor Room illuminated at all times Falls prevention poster Non-exit side rails up for support Exit side head rail up for support and foot rail down at all times. Movable hand rail (Hemiwalker) always within reach Non-slip floor mat absorbs fluids, food, & stool, and prevents slips

22 Program fiscal support UMASS MEMORIAL MEDICAL CENTER RISK MANAGEMENT LOSS PREVENTION GRANT PROGRAM The UMassMemorial Medical Center Dept. of Risk Management supported the fall prevention task force proposal to implement this program.

23 Purpose The purpose of this quality improvement initiative was to evaluate the effectiveness of a hospital based falls prevention training program.

24 Methods This study was guided by the Precede Proceed framework

25 PRECEDE / PROCEED Phase 9 Outcome Evaluation Phase I Social Assessment Phase 8 Impact Evaluation Phase 2 Epidemiological Assessment Phase 7 Process Evaluation Phase 3 Behavioral and Environmental Assessment Phase 6 Implementation Phase 4 Education and Ecological Assessment Phase 5 Administrative Policy

26 Methods Purposive sampling of Licensed, Certified, and Ancillary personnel on three acute care units.

27 Sample Demographics 70 Lic staff (RN) PCA Non-nursing staff RN PCA Non Nsg

28 Methods Coordinator of the Co-Gems education program of the University Of Massachusetts Graduate School Of Nursing conducted a Train the Trainer fall prevention instructor training to prepare 12 unit manager selected nursing staff at Memorial Campus to the Co-Gem teaching philosophy with a specific focus on fall prevention.

29 Methods Trained trainers were given education content and given peer leadership training to implement trainings for there nursing unit colleagues.

30 Methods Preliminary testing provided the caregivers baseline falls related knowledge, prior to receiving the education intervention.

31 Methods Post education intervention tests were compared to pre education test to establish if learning had taken place at the education intervention.

32 Methods 90 day post education intervention post tests were given to establish if learned falls knowledge was retained.

33 Methods Falls rates were evaluated prior to intervention, and at 30, 60, 90, and 120 days post intervention.

34 Methods Fall prevention risk assessment and fall prevention asst devices were introduced on each of the participating acute care units, with training from Nursing Professional Development Educators.

35 Methods Patient and Family Education Materials Patient education materials adapted by the Centers Disease Control falls toolkit, include: What you can do to prevent falls brochure in both English and Spanish, Check for Safety home safety checklist in both English and Spanish as well as Fall prevention education posters in English and Spanish have been distributed to each participating care units, ambulatory clinics and Memorial ED.

36 Methods

37 Results Preliminary testing evaluation revealed opportunities for additional learning among the care providers. Initial training Post test evaluation demonstrated learning had taken place at training sessions.

38 Program Evaluation Awareness and improved understanding of falls was achieved through the education process. The 90-Day post tests demonstrated that learning did occur and was retained over a span of time.

39 Conclusion The role of falls risk assessment, awareness, and education for the prevention of falls in older adults and hospitalized patients is critical. This program demonstrates the effectiveness of an educational intervention for preventing falls in the acute care setting. Highlighted the mutual benefit of a partnership between a graduate school of nursing and an acute care facility

40 Continuity of the Continuum of care From Hospital to Home: Together; Acute Care, Home Care, Long Term and Rehabilitation Care providers can reduce the risks of patients falls and reduce fall rates and fall injuries.

41 On behalf of UMass Memorial Healthcare Services, and the Massachusetts Fall Prevention Coalition, we thank you for your efforts of reducing the risk of falls. Patricia A. MacCulloch MS, APRN Adult Nurse Practitioner UMass Memorial Healthcare Services Department of Orthopedics

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