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Fall prevention for the Elderly Population | VITAS Healthcare
Falls are the leading cause of injury for elderly adults. One in three adults over 65 falls each year, and falls are the cause of half of all trauma deaths among elderly patients. Nursing home residents are at especially high risk, with 30-40% sustaining significant falls. A comprehensive assessment identifies medical, environmental, and personal risk factors. A multidisciplinary team implements an individualized care plan with education, exercise, medication management, assistive devices, and environmental safety strategies to prevent falls and injuries among elderly patients.
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Introduction to fall prevention emphasizing strategies and goals to reduce fall incidents.
Introduction to fall prevention emphasizing strategies and goals to reduce fall incidents.
Statistical data highlight the severity of falls in the elderly, including injury rates and economic costs.
Discussion of environmental, personal, and medical factors contributing to fall risks among older adults.
Examines how fear of falling affects mobility and overall health in elderly individuals.
Methods to assess fall risk, differentiating between low-risk and high-risk individuals.
Details on the coordinated team approach for care planning and education to prevent falls.
Strategies for ongoing monitoring and addressing environmental risks to enhance safety.
Emphasis on reviewing medications to minimize side effects and interactions that increase fall risk.
Recommendations for suitable footwear, use of assistive devices, and the importance of exercise.
Guidelines for responding to falls, including assessment and follow-up procedures.
Recap of the presentation's main points on falls together with engagement for questions.
Citations from authoritative sources used throughout the presentation on fall prevention.
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Fall prevention for the Elderly Population | VITAS Healthcare
- 1. Fall Prevention forElderly Population Risk Factor & Strategies for Prevention
- 2. CE Provider Information VITASHealthcare programs are provided CE credits for their Nurses/Social Workers and Nursing Home Administrators through: VITAS Healthcare Corporation of Florida, Inc/CE Broker Number: 50-2135. Approved By: Florida Board of Nursing/Florida Board of Nursing Home Administrators/Florida Board of Clinical Social Workers, Marriage and Family Therapy & Mental Health Counseling. VITAS Healthcare programs in Illinois are provided CE credit for their Nursing Home Administrators and Respiratory Therapists through: VITAS Healthcare Corporation of Illinois, Inc./8525 West 183 Street, Tinley Park, IL 60487/NHA CE Provider Number: 139000207/RT CE Provider Number: 195000028/Approved By the Illinois Division of Profession Regulation for: Licensed Nursing Home Administrators and Illinois Respiratory Care Practitioner. VITAS Healthcare programs in California/Connecticut/Delaware/Illinois/Northern Virginia/Ohio/Pennsylvania/Washington DC/Wisconsin are provided CE credit for their Social Workers through VITAS Healthcare Corporation, provider #1222, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. VITAS Healthcare maintains responsibility for the program. ASWB Approval Period: (06/06/15 - 06/06/18). Social Workers participating in these courses will receive 1-2 clinical or social work ethics continuing education clock hour(s). {Counselors/MFT/IMFT are not eligible in Ohio} VITAS Healthcare Corporation of California, 310 Commerce, Suite 200, Irvine, CA 92602. Provider approved by the California Board of Registered Nursing, Provider Number 10517, expiring 01/31/2019. Exceptions to the above are as follows: AL: No NHAs, DE: No NHAs, DC: No NHAs, GA: No NHAs, KS: No NHAs, NJ: No NHAs, OH: No NHAs, PA: No NHAs, TX: No NHAs, VA: No NHAs, WI: No NHAs and Nurses are not required – RT only receive CE Credit in Illinois 06-2017
- 3. Goal • The goalof this presentation is to learn the reasons for falls and to develop effective fall prevention strategies
- 4. Objectives • Describe theincidence of falls in the elderly patient • Define conditions contributing to falls • Identify risk factors related to falls • Explain and complete the basic fall assessment • Describe the team approach to reduce falls
- 5. The Reality • Inthe next 17 seconds, an older adult will be treated in a hospital emergency department for injuries related to a fall. • In the next 30 minutes, an older adult will die from injuries sustained in a fall.
- 6. Statistics on Falls •One out of three adults age 65 and older falls each year • Falls are the leading cause of injury among adults age 65 years and older in the United States • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments
- 7. Injury & Death •Adults over 70 are three times as likely to die following low-level falls • Although elderly patients account for less than 15% of trauma admissions due to falls, they account for half of deaths due to falls. Only half survive past one year post hospitalized fall
- 8. Fall-Related Deaths • In2009, about 20,400 older adults died from unintentional fall injuries. • Men are more likely than women to die from a fall. • Falls are the most common cause of traumatic brain injuries and accounted for 46% of fatal falls among older adults.
- 9. Falls in theFacility • Approximately 50% of individuals living in a long-term care facility will sustain a fall • One in every 10 residents who falls has a serious related injury; about 65,000 patients suffer a hip fracture each year. • Each year, a typical nursing home with 100 beds reports 100 to 200 falls. • Patients often fall more than once. The average is 2.6 falls per person per year. About 1 in 3 residents fall two or more times per year!
- 10. Falls in theFacility (Cont.) • Approximately 30% to 40% of residents will sustain a significant fall in their lifetime. • About 1,800 older adults living in nursing homes die each year from fall-related injuries • Residents account for about 20% of deaths from falls in this age group. About 35% of fall injuries occur among residents who cannot walk!
- 11. Implications of Statistics •Medical costs for falls have been reported at approximately $179 million for fatal falls, and $19 billion for non-fatal injuries
- 12. Risk Factors • Environmental •Personal • Medical
- 13. Environmental Risk Factors Environmentalhazards in nursing homes cause 16% to 27% of falls • Poor lighting • Slick or irregular floor surfaces • Furniture that is too high or low • Unsafe stairways • Improperly maintained wheelchairs • No support in bathrooms
- 14. Personal Risk Factors •Age – The risk for falling increases with age • Activity – Exercise helps to strengthen and improve balance • Habits – Excessive alcohol intake and smoking decrease bone strength • Diet – A poor diet and not getting enough water will deplete strength and energy
- 15. Medical Risk Factors •Generalized weakness • History of falls • Cardiac arrhythmias, blood pressure fluctuation • Depression, dementia, Alzheimer’s disease • Use of assistive device • Cancer that affects the bones • Gait limitations • Visual & hearing impairment
- 16. Falls Related toMedications • Drugs that may directly lead to falls: – sedatives – anxiolytics – antidepressants – anti-hypertensives • Drugs that may affect the outcome of falls: – anticoagulants – aspirin
- 17. Fear of Falling •Fear of falling may cause some people to limit their activities • Reduced mobility further increases fall risk • Inhibits social and functional status – Walking – Shopping – Taking part in social activities • Inactivity leads to a decrease in body system functions – Decreased circulation -> Decreased kidney function -> Increased risk of infection
- 18. Assessment • History ofprevious falls • Oxygenation • Altered level of consciousness • Impaired judgment • Unmanaged pain • Diagnoses that affect cognition or perfusion • Sensory deficits • Inappropriate footwear • Postural hypotension • Functional impairment • Urinary frequency, urgency & nocturia • Medications
- 19. Common Low-Risk Factors Apatient at low risk for injury from falling from bed: • Is able to transfer safely from bed to wheelchair • Ambulates without assistance • Has not fallen or is unlikely to fall from bed • Requests assistance appropriately
- 20. Common High-Risk Factors Apatient at high risk for injury from falling from bed: • Does not have the ability to safely transfer from bed to wheelchair • Has a history of falling out of bed • Is not able to ambulate safely • Is inconsistent about requesting help
- 21. Team Approach toFall Prevention Care Planning • Education • Elimination needs • Monitoring and assessment − Safety concerns − Medications • Exercise and assistive devices
- 22. Care Planning • Oncea patient has been identified as being at risk for falling, a safety care plan should be created and implemented by the interdisciplinary team
- 23. Care Planning (Cont.) •Coordination of care ̶ All interventions should involve education to the patient, family or caregiver • Appropriate assistive devices and equipment • Encourage activity as tolerated and exercise per patient ability
- 24. Education • Increase staffawareness of patient risk ̶ Use risk factors to guide assessments ̶ Emphasize prevention vs. reaction ̶ Improve compliance with staffing consistency • Utilize standard resources ̶ Fall Prevention & Management Best Practice ̶ WINK about Falls
- 25. Elimination Needs • Usean individualized approach ̶ Address in Care Plan • Provide supplies and ordered treatments • Keep commode and urinal close to the bed • Implement and teach safe transfers • Avoid ‘I’ll be right back’ syndrome
- 26. Importance of Monitoring •Monitoring patient activity – Prioritize the patient’s needs and risk factors – Create a monitoring schedule – Electronic monitors can assist – Assess alarm effectiveness – Consider using a baby monitor
- 27. Environment • Enlist familyand visitors with observation • Assess, document and monitor for safety hazards • Scatter rugs, handrails, loose or unsafe floor coverings • Utilize team resources to resolve safety issues • Continue to monitor on an ongoing basis
- 28. Medication Review • Reviewfor side effects/interactions • Teach patients and families about medications • Encourage administration of diuretics in AM hours • Encourage consistent use of oxygen when needed to prevent dizziness and confusion • Close monitoring of and specific safety education focused on medications known to increase the risk of falls or increase the risk of injury related to falls
- 29. Safe Medication Use •Review medications on an ongoing basis • Ask the attending physician to discontinue unnecessary, inappropriate or ineffective medications • Schedule medications appropriately ̶ Do not give diuretics late in the day ̶ If possible, schedule sedating medications close to bedtime, etc.
- 30. Safe Medication Use(Cont.) • Teach patient and family what to expect when starting on a new medication • Teach patient, family and caregivers to use oxygen when it is needed—hypoxia can lead to confusion and anxiety, thus increasing fall risk • Use of IP or continuous care when medication changes may produce symptoms that need to be managed or require assessment of effectiveness of medication doses
- 31. Look Up andLook Down • Visual appliances ̶ Assure that eye wear is appropriate, clean and utilized • Footwear ̶ Shoes can affect balance—check for fit ̶ Low-heeled walking shoes are best ̶ Shoes with large, soft soles (which may include many athletic shoes) may increase risk of falls
- 32. • Exercise ̶ Regular ̶Balance training ̶ Resistance ̶ Strength ̶ If able to walk, walk! • Assistive Devices ̶ Bed alarms ̶ Canes ̶ Walkers ̶ Hip protectors ̶ Wheelchairs ̶ Lifts Exercise & Assistive Devices
- 33. Immediately After aFall • DO NOT move the patient until type of injury is determined. • If emergency: ̶ Follow facility protocols ̶ Assess for injury ̶ Notify MD and supervisor • If not an emergency: ̶ Assist patient to safety ̶ Assess for injury ̶ Notify MD and supervisor
- 34. Follow-up After aFall • Search for cause of fall and intervene • Complete required paperwork • Repeat assessment in appropriate time frame • Monitor patient at intervals for risk factors
- 35. In review, we: •Described the incidence of falls in the elderly patient • Defined conditions contributing to falls • Identified risk factors related to falls • Explained how to complete the basic fall assessment • Described the team approach to reduce falls
- 36.
- 37. References • American Academyof Orthopaedic Surgeons (2012). Guidelines for Preventing Falls. Orthoinfo. Retrieved from http:://orthoinfo.aaos.org/topic.cfm?topic=A00135 • Aschkenasy, M. & Rothenhaus, T. Trauma and Falls in the Elderly. Emerg Med Clin N Am 24 (2006) 413-432 • Centers for Disease Control (2005) . Cost of Fall Injuries in Older Persons in the United States. Retrieved from: http://www.cdc.gov/homeandrecreationalsafety/falls/data/cost- estimates.html • Centers for Disease Control (2012). Falls among Older Adults: An Overview. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html • Centers for Disease Control (2012). Falls in Nursing Homes. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html • Mayo Clinic (2013) Fall Prevention: 6 Tips to Prevent Falls. Retrieved from:tp://www.mayoclinic.com/health/fall-prevention/HQ00657
- 38. References (Cont.) • NationalInstitute of Health – National Institute on Aging, Age Page. Falls and Fractures. Retrieved from: http://www.nia.nih.gov/health/publication/falls-and-fractures • Parker-Pope, T. A List of Drugs that Increase Falling Risk. New York Times (July 10, 2008). Retrieved from:http://well.blogs.nytimes.com/2008/07/10/a-list-of-drugs-that- increase-falling-risk/ http://uncnews.unc.edu/impages/stories/news/health/2008/drugslist.pdf • Riefkohl, E.Z., Bieber, H.L.,Burlingame, M.B., and Lowenthal, D.T. Medications and Falls in the Elderly: A Review of the Evidence and Practical Considerations. P&T (November 2003) Vol. 28, No. 11. Retrieved from: http://www.ptcommunity.com/ptjournal/fulltext/28/11/PTJ2811724.pdf • Spanjolas K. Cheng J.D., Gestring M.L. Et al. Ground level falls are associated with significant mortality in elderly patients. JTrauma. Oct 2010;69(4): 821-825 • Stevens J.A., Corso P.S., Finkelstein E.A., Miller T.R. The costs of fatal and non-fatal falls among older adults
- 39. References (Cont.) • Stevens,J.A. & Dellinger, A.M. Motor-Vehicle and Fall-Related Deaths among Older Americans 1990-98: sex, race, and ethnic disparities. Injury Prevention (2002) 8: 272-5. • Taylor, J, Parmelee, P, Brown, H. & Ouslander, J. The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities. Center for Health in Aging and the Emory University Division of Geriatric Medicine and Gerontology, Department of Medicine, October 2005. Retrieved from: http://www.ahrq.gov/professionals/systems/long-term- care/resources/injuries/fallspx/fallspxmanual.html
- 40. Fall Prevention forElderly Population Risk Factor & Strategies for Prevention
Editor's Notes
- #2 Length: 60 minutes. Continuing Education Credit: Approved for one credit. Target Audience: Health care workers and others who care for hospice patients and their families. Social workers participating in this course will receive __1__ (clinical) continuing education clock hours. Facilitator: Welcome to this training entitled: Fall Prevention for Elderly Population. Allow me to introduce myself. I am (state your name and position).
- #4 Our goal today is: To learn why falls occur and develop effective fall prevention strategies thus reducing the number of falls for patients.
- #5 By the end of today’s presentation you will be able to: Describe the incidence and complications of falls in the senior patient population. Define conditions contributing to falls. Identify intrinsic and extrinsic factors related to falls. Explain the basic fall assessment and complete the assessment tool appropriately. Describe the team approach to reduce falls.
- #6 Let’s begin with a reality check! In the next 17 seconds, an older adult will be treated in a hospital emergency department for injuries related to a fall. In the next 30 minutes, an older adult will die from injuries sustained in a fall Source: Centers for Disease Control Cost of Fall Injuries in Older Persons in the United States, 2005 http://www.cdc.gov/homeandrecreationalsafety/falls/data/cost-estimates.html
- #7 Here are some facts: One out of three adults age 65 and older falls each year Falls are the leading cause of injury among adults aged 65 years and older in the United States. It can result in severe injuries such as hip fractures and head traumas. Many older adults, even if they have not suffered a fall, become afraid of falling and restrict their activity, which drastically decreases their quality of life. Source: Centers for Disease Control Cost of Fall Injuries in Older Persons in the United States, 2005 http://www.cdc.gov/HomeandRecreationalSafety/falls/data/cost-estimates.html In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized. Source: Centers for Disease Control Falls Among Older Adults, September 20, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htm
- #8 For the elderly, even short falls can be deadly. Adults over 70 are three times as likely to die following low-level falls Source: Spaniolas, K. Cheng, J.D., Gestring, M.L., et al.Trauma (2010) 69(4): 821-825. Low-level falls (falls from a standing height) are the most common reason for injury in geriatric patients. Complications resulting from falls are the leading cause of death from injury in men and women older that age 65. The incidence of falls increases with age over 64 years and varies according to living status. Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand. Source: Falls Among Older Adults: An Overview September 20, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htm Injuries sustained by geriatric patients from falls tend to be more severe than the injuries sustained by younger patients from similar falls. Injuries to the head, pelvis, and lower extremities are extremely common. Although elderly patients account for less than 15% of trauma admissions due to falls, they account for half of deaths due to falls. Overall mortality is about 11%. High-level falls (over 15 feet) in the elderly are less common, but carry a mortality approaching 25%. Increased morbidity is associated with increased disability, hospital admissions, and inpatient length of stay. Source: Aschkenasy, M & Rothenhaus,T Trauma and Falls in the Elderly Emerg Med Clin N Am 24 (2006) 413–432http://www.smmemx.org/Documentos/Trauma/TraumaFalls.pdf Of patients hospitalized after a fall, only about half are alive one year later. Source: Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
- #9 In 2009, about 20,400 older adults died from unintentional fall injuries. The death rates from falls among older men and women have risen sharply over the past decade. Men are more likely than woman to die from a fall. After taking age into account, the fall death rate in 2009 was 34% higher for men than for women. Source: Falls Among Older Adults: An Overview September 20, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html Falls are the most common cause of traumatic brain injuries (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults.
- #10 People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer. Source: Falls Among Older Adults: An Overview September 20, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html 50% of individuals living in a Long Term Care facility will sustain a fall. One in every 10 residents who fall has a serious related injury and about 65,000 patients suffer a hip fracture each year. Rates of fall-related fractures among older women are more than twice those of men. Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Source: Falls in Nursing Homes Centers for Disease Control, February 29, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html 30 to 40 percent of residents fall 2 or more times. Source: Taylor, J, Parmelee, P, Brown, H. & Ouslander, J. The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities Center for Health in Aging and the Emory University Division of Geriatric Medicine and Gerontology, Department of Medicine, October 2005 http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanual.html
- #11 Falling can be a sign of other health problems. People in nursing homes are generally frailer than older adults living in the community. They are usually older, have more chronic conditions, and have more difficulty walking. They also tend to have thought or memory problems, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves. All of these factors are linked to falling. About 35% of fall injuries occur among residents who cannot walk! Approximately 30% - 40% of community-dwelling seniors will sustain a significant fall in their lifetime. Source: Aschkenasy, M & Rothenhaus,T Trauma and Falls in the Elderly Emerg Med Clin N Am 24 (2006) 413–432 http://www.smmemx.org/Documentos/Trauma/TraumaFalls.pdf About 1,800 older adults living in nursing homes die each year from fall-related injuries and those who survive falls frequently sustain hip fractures and head injuries that result in permanent disability and reduced quality of life. Patients often fall more than once. The average is 2.6 falls per person per year. Source: Falls in Nursing Homes Centers for Disease Control, February 29, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html
- #12 The implications of these facts indicate that falls can result in painful and costly injuries, fear of falling, less participation in activities, and lower quality of life. Research indicates that direct medical costs have been reported at approximately $179 million for fatal falls and $19 billion for nonfatal fall injuries. Source: Stevens J.A., Corso PS, Finkelstein E.A., Miller T.R. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290–5. http://www.ncbi.nlm.nih.gov/pubmed/17018668
- #13 Risk factors for fall can be divided into three basic categories: Falls related to the environment Falls directly related to the individual’s unique make-up; and Falls due to the person’s medical condition(s)
- #14 Environmental hazards in nursing homes cause 16% - 27% of falls . The basic risk factors include, but are not limited to: Muscle weakness and walking or gait problems Poor lighting. Slick or irregular floor surfaces. Furniture that is too high or too low. Unsafe stairways. Improperly maintained wheelchairs. No support in bathrooms. Source: Mayo Clinic (2013) Fall Prevention: 6 Tips to Prevent Falls. Retrieved from: http://www.mayoclinic.com/health/fall-prevention/HQ00657 Source: National Institute of Health – National Institute on Aging, Age Page. Falls and Fractures http://www.nia.nih.gov/health/publication/falls-and-fractures
- #15 In the area of personal risk factors, here are the common elements which will affect fall risk: Age - The risk for falling increases with age Activity - Exercise helps to strengthen and improve balance Habits - Excessive alcohol intake and smoking decrease bone strength Diet - A poor diet and not getting enough water will deplete strength and energy
- #16 There are medical risk factors for falls. Lets review them. Generalized and muscle weakness History of falls Cardiac arrhythmias, blood pressure fluctuation Depression, dementia, Alzheimer’s disease Use of assistive device Cancer which affects the bones Walking or gait problems/limitations Visual & hearing impairment Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids. Source: Guidelines for Preventing Falls, Orthoinfo American Academy of Orthopaedic Surgeons, October 2012 http://orthoinfo.aaos.org/topic.cfm?topic=A00135
- #17 Medications can increase the risk of falls and fall-related injuries Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern. Source: Parker-Pope, T. A List of Drugs that Increase Falling Risk. New York Times, July 10, 2008. Retrieved from: http://well.blogs.nytimes.com/2008/07/10/a-list-of-drugs-that-increase-falling-risk/ http://uncnews.unc.edu/images/stories/news/health/2008/drugslist.pdf Anti-hypertensive's can significantly lower blood pressure, resulting in risk for syncope, vertigo and falling. Anticoagulants and aspirin increase the probability of injury post fall. Source: Riefkohl, E.Z., Bieber, H.L.,Burlingame, M.B., and Lowenthal, D.T. Medications and Falls in the Elderly: A Review of the Evidence and Practical Considerations P&T November 2003 Vol. 28, No. 11. Retireved from: http://www.ptcommunity.com/ptjournal/fulltext/28/11/PTJ2811724.pdf
- #18 Once a fall occurs, a downward chain of events is set into motion, which has a negative impact on mobility. Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling. Reduced mobility further increases fall risk It also inhibits social and functional status, such as avoiding: Walking Shopping Taking part in social activities Source: Falls Among Older Adults, CDC, September 20, 2012 http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html Source: Aschkenasy, M & Rothenhaus,T Trauma and Falls in the Elderly Emerg Med Clin N Am 24 (2006) 413–432 http://www.smmemx.org/Documentos/Trauma/TraumaFalls.pd Inactivity results in decreased circulation, which leads to compromised bladder and kidney function, increasing the risk for infection.
- #19 Let’s talk about some of the factors to assess: Is there a history of previous falling? Is there sufficient oxygenation to prevent dizziness? Observe the level of consciousness: Is the person awake? Alert? Drowsy? Non-responsive? Does the person have any awareness of deficits? Do they have the ability to learn and adhere to the plan of care? Is there agitation that may precipitate climbing out of bed or chair? Is there any observable impairment in judgment? Is the patient reporting unmanaged pain? Are there any sensory deficits? Review visual , speech, and auditory abilities: Is the patient using appropriate footwear? Has there been any drop in blood pressure due to a positional change? Has there been any change in functional status? Has the patient’s ability to ambulate changed? How is the ability to perform activities of daily living affected? Is there someone available to assist with ambulation and transfers? How are the Urinary and Gastrointestinal Systems affected? Evaluate urinary frequency, urgency, & nocturia: Will urgency cause them to try to get out of bed and to the bathroom? Evaluate bowel status: Do they have any diarrhea that may cause a need to get to a bathroom? Has there been a diagnosis which affects cognition? Review medications: Check for anti-anxiety or anti-hypertensive's which create a risk for falls. All of this assessment data is collected upon admission to hospice, to a nursing home as Minimum Data Set and Resident Assessment Protocols, and upon comprehensive assessments performed by clinical staff.
- #20 A patient at low risk for injury from falling from bed is one who: Is able to transfer safely from bed to wheelchair Ambulates without assistance Has not fallen or is unlikely to fall from bed Requests assistance appropriately
- #21 A patient at high risk for injury from falling from bed is one who: Does not have the ability to safely transfer from bed to wheelchair Has a history of falling out of bed Is not able to ambulate safely Is inconsistent about requesting help
- #22 A team approach is necessary to assist patients that are at risk. The basis of that team approach is CARE PLANNING – which includes: Education. Assessing elimination needs. Monitoring and assessment; of both safety concerns and medications. Exercise and assistive devices.
- #23 Once a patient has been identified as being at risk for falling, a safety care plan should be created and implemented by the interdisciplinary team.
- #24 Additionally, with Coordination of Care, All interventions should involve education to the patient, family or caregiver Appropriate assistive devices and equipment should be put in place You should encourage activity and exercise, as much as the patient is able to tolerate
- #25 Lets take a look at each of these in detail. We must educate our patients, families, and care partners to increase awareness of patient risk Use risk factors to guide assessments- review diagnoses, co-morbids, medications, patient’s level of awareness, and ability to comply with the plan of care. Emphasize prevention vs. reaction. Make every effort to improve compliance with staffing consistency. This will increase the patient’s sense of security and in turn, they will have confidence that they will receive a timely response to their needs. Additionally, you should utilize the standard resources on Fall Prevention available to all clinical staff, such as:
- #26 We will address elimination needs to help prevent falls: It is important to use an individualized approach; care plans are always individualized. Meet elimination needs by providing supplies, equipment, and ordered treatments, such as foley catheters. Teach families and caregivers to keep the commode and urinal close to the bed. Implement and teach the safe way to transfer the patient from bed to commode. Teach caregivers to avoid the syndrome of ‘I’ll be right back’ and make every effort to be quickly responsive to patient’s needs
- #27 How can we monitor the patient’s activity? We need to prioritize needs based on risk factors- think ‘ triage’ care – use critical thinking skills. Electronic monitors can assist with observation. Alarm effectiveness depends on value perceived by the staff. Alarms use may soon be viewed as a minimum standard of care. Use of a baby monitor is a viable option
- #28 We must monitor the environment for safety issues: Enlist family and visitors with observation. Ensure that all exit alarms are in working order – incorporate into co-ordinate plans of care when appropriate. Ensure that all visiting staff update the ‘Environment/Safety’ section of the note to add and modify existing safety issues as needed. Assess safety hazards that may exist – scatter rugs, hand rails, loose or unsafe floor coverings. Communicate safety issues with the team – Utilize critical comments, voicemail, team meeting to discuss. Continue to monitor safety on an ongoing basis.
- #29 Review all medications for possible interactions and side effects that could lead to dizziness, disorientation, and falls. Teach patients and families about medications and possible side effects. Utilize handouts whenever possible to reinforce teaching. Encourage responsible administration of diuretics in the A.M. so the patient does not awaken during night with urge to urinate. Encourage use of oxygen when necessary. Lack of oxygen can lead to dizziness and confusion, increasing the risk for falls. Close monitoring of and specific safety education focused on medications known to increase the risk of falls or increase the risk of injury related to falls
- #30 Review of medications on an ongoing basis Ask the attending physician to discontinue unnecessary, inappropriate, or ineffective medications Schedule medications appropriately Do not give diuretics late in the day If possible, schedule sedating medications close to bedtime as possible, etc.
- #31 Teach patient and family what to expect when starting on a new medication Teach patient, family and caregivers to use oxygen when it is needed—hypoxia can lead to confusion and anxiety, thus increasing fall risk Use of IP or Continuous care when medication changes may produce symptoms that need to be managed or assessment of effectiveness of medication doses
- #32 Sometimes, the basics are important to evaluate: If the patient needs any type of eyewear, check that it is appropriate, clean, and utilized. Balance and sway can be affected by the type of shoes worn. Check for proper fit. Low heeled, walking shoes are best. Shoes with large, soft soles, which may include many athletic shoes, may increase risk of falls
- #33 Exercise is important to maintaining physical strength and functioning The following modes of exercise may be encouraged if possible: Active and/or passive range of motion. Balance training. Resistance. Strength training. If the person is able to walk, then they should walk! Advocate for your patient who may benefit from the use of assistive devices. These include: Bed alarms. Wheelchairs. Canes. Walkers. Hip protectors. Lift devices – these are an excellent and effective way to lift patients safely. Remember to monitor the equipment that is in the home/facility for wear and possible mechanical failures. If any problems are observed, communicate with the team and DME provider.
- #34 Despite precautions, should a patient fall: DO NOT move the patient until type of injury is determined. If emergency, follow facility protocols, assess for injury, call the MD, and involve your supervisor. If not an emergency: Assist the patient to safety. Assess the patient. Notify the MD and your supervisor. Complete any appropriate forms necessary.
- #35 Once the patient is safe, and assessed for injury, the follow-up process includes: Notify any parties involved, who may include family or other doctors involved in care. Search for cause of fall and intervene by updating the Plan of Care and providing additional education if necessary. Complete any internal paperwork required. Repeat the assessment in an appropriate time frame. Monitor patient at intervals to assure that any risks are addressed.
- #36 In Review, we: Described the incidence and complications of falls in the senior patient population. Defined conditions contributing to falls. Identified intrinsic and extrinsic factors related to falls. Explained the basic fall assessment and complete the assessment tool appropriately. Described the team approach to reduce falls.
- #37 Before we conclude, do you have any questions?
- #41 Facilitator: Please leave slide until the last attendee has left the room.