Fall Prevention

1. Fall Prevention Don't Fall for IT! IN-SERVICE TRAINING GUIDE

2. Process Objective • To increase the awareness of reasons for falls • Identify the residents in your home that are at risk

3. How big is the problem? • Each year, one in every three adults age 65 and older falls • Among older adults (those 65 or older), falls are the leading cause of injury death

4. How big is the problem? • Many people who fall, even if they are not injured, develop a fear of falling • Residents are most likely to fall during the first two to three weeks after admissions into a healthcare facility

5. How big is the problem? • The number of falls per year is expected to increase as the population increases • Each year, a typical nursing home with 100 beds reports 100 to 200 falls • Most fractures among older adults are caused by falls

6. How big is the problem? • Majority of falls occur during routine activities • Bathroom, most likely place for fall to occur • Use extra precautions when pets are around– they can get under foot

7. Who is at risk? • The death rates from falls among older men and women have risen sharply over the past decade • Falls may be a warning sign of an acute underlying medical issue. • An acute change in a resident’s condition may be related to an un-witnessed fall

8. Who is at risk? • About 5% of adults 65 and older live in nursing homes but nursing home residents account for about 20% of deaths from falls in this age group • Between half to three-quarters of nursing home residents fall each year

9. Who is at risk? • Residents often fall more than once • About 35% of fall injuries occur among residents who cannot walk

10. Why do falls occur more often in nursing homes? • Falling can be a sign of other health problems • People in nursing homes are generally frailer than older adults living in the community • Nursing home residents have more chronic conditions and have more difficulty walking • They also tend to have thought or memory problems

11. Most common causes of nursing home falls? • Medications can increase the risk of falls and fall-related injuries. • Muscle weakness and walking or gait problems • Environmental hazards in nursing homes cause 16% to 27% of falls among residents.

12. Tips to Remember…. • Clutter- Most res live in small, shared rooms. A clear space of 2-3 feet around the bed is needed. Keep over bed tables across the bed when not in use. Secure cords out of walking area. • Bed Wheels – an unstable bed can roll out from underneath the resident during transfer. • Light Furniture- Can tip over when res uses it for support. • Chairs with out arms - should not be used. Use B/S commodes with caution and be sure they have rubber tips on all 4 legs.

13. More Tips to Remember… • Poor lighting – Elderly persons need 2-3 times more light than young adults to see clearly. • Hard to reach items – If a resident has to reach beyond her center of gravity, she may fall. Keep call lights, water pitchers, glasses & phone within easy reach. • Footwear – Painful foot conditions may prevent resident from distributing weight evenly when standing and from wearing safe shoes.

14. Fall Prevention / Solutions • It requires a combination of medical treatment, rehabilitation, and environmental changes. • The most effective interventions address multiple factors or use a multidisciplinary team.

15. Fall Prevention / Solutions • Immediately assess the resident and the surrounding environment after a fall • Educating staff – everyone is part of solution! • Reviewing prescribed medicines • Making changes in the nursing home environment

16. Fall Solution Suggestions • Providing patients with hip pads • Exercise programs • Teaching behavioral strategies

17. Unsafe Behaviors • Resident tries to stand, transfer, or walk alone unsafely • Resident climbs over bedrails or tries to get out of bed alone unsafely • Resident walks or paces when too tired to be safe • Resident propels wheelchair or walks alone in unsafe areas such as outdoors on rough pavement or in a parking lot • Resident is combative during care

18. Unsafe Behaviors • Behavior Patterns – how often, what time of day & where? • Triggers – is there something that usually happens just before? • Motivation – attempt to better understand the resident’s needs. • Staff Experience – what has worked and not worked in the past? • Medications – consider side effects & medical problems.

19. Process Indicator Approach • Assessment and problem recognition • Diagnosis and cause identification • Treatment and management • Monitoring

20. Assessment • Vision problem? • Related medical? • Pain Assessment? • Improper use of a device? • Independent in ambulation ?

21. Assessment is the cornerstone of a fall prevention program. • Taking an adequate history • Identifying those at risk • Identifying acute and reversible problems • Communicating with the physician • Wheelchair positioning assessments to become a component of the initial occupational therapy assessment of all admissions

22. Cause Identification • Immediately ask the resident what they were trying to do just before the fall • Search for underlying medical problems • Assessment of environmental factors • Review of medication regimen • Physician involvement in diagnosis of the problem • When is an evaluation not necessary

23. Time of day Time since last meal Medications, (including Over The Counter) What was resident doing or trying to do Usual or unusual activity Standing still, walking, reaching up or down Changes in environment Refusal to use assistive devices Effectiveness of previous safety measures Factors to Consider After a Fall

24. PAST FALLS • Information on previous falls • Time • Activity during that time • Body position during that time • Purpose of activity during fall • Environmental concerns • Pattern of falls

25. Remember • A fall without injury is still a fall • A fall without a witness is still a fall • The distance of the fall is not a factor in determining a fall

26. Care Plan • Development of a care plan that contains cause-specific interventions to prevent or minimize resident falls • A fall requires an intervention and an update to plan of care! • It may be necessary to use a combination of interventions

27. ProgramInterventions • Bowel and bladder program • Activities program • Rehabilitation: gait training, muscle strengthening, balance training • Education programs about safety • Programs for residents who seem to “wander” • Nutrition and hydration program

28. Teamwork • Empowerment of all staff • Caregiver Involvement • Housekeeping, Maintenance, and Dietary Staff • Active Involvement • Medical Director

29. Documentation • Document in the patient’s record, the facts pertaining to the fall and treatment. • Complete other institutional documentation as directed.

30. Summary • Falls can be reduced or eliminated • Do a thorough assessment • Correct what you can • Place on correct prevention program based on assessment • Document all the steps of the process • The importance of effective risk assessment, care planning and monitoring of interventions on an interdisciplinary basis is vital to success

31. Q A & A Committee • Fall Team should track outcomes of care plan interventions and report the results monthly to the facility’s Q A & A committee. • They should also include details of all incidents and trends related to falls and injuries. Also, note successful interventions; resident and facility specific. • Discussion of plans to further educate staff, residents and their families should also be included in documentation.

32. Your Turn…… Questions? Concerns? Comments?

33. Thank you for all that you do to keep our residents safe!