Eliminating Restraints and Alarms While Monitoring Your Falls Program

2. Eliminating Restraints and Alarms While Monitoring Your Falls Program Mary Funseth, CSW, CIRS-A Jody Rothe, RN, WCC March 16, 2010

3. Objectives • Describe how to make a falls management program part of your daily practice • Identify methods to balance a person centered approach to care and meeting regulations • Apply person directed, person centered focus and interventions to the care plan

4. Fall Prevention • The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities • http://www.metastar.com/web/Default.aspx?tabid=331 • State Operations Manual • 323

5. Regulation • 323 Accidents and Supervision • The resident environment remains as free from accidental hazard as is possible • Each resident receives adequate supervision and assistance devices to prevent accidents

6. Definitions • Accident • Avoidable Accident • Unavoidable Accident • Fall • Supervision/Adequate Supervision

7. Commitment to Safety • Systems approach • Identify risks and hazards • Evaluation and analysis of risks and hazards • Implementation of interventions • Monitor for effectiveness and modification of interventions when necessary

8. Commitment to Safety • Ascertain if there were injuries and provide treatment as necessary • Determine what may have caused or contributed to the fall • Address the factors for the fall • Revise resident care plan and/or facility practices, as needed, to reduce another fall

9. The Falls Management Program • Introduction and Program overview • Causes of falls • Intrinsic • Extrinsic • Overview of Falls Management Program

10. Culture of Safety • Strong leadership • Clearly defined Safety Policies • All staff to identify and report concerns • Empowerment of staff to correct problems • Enforcement of policies and by supervisors and management • Regular measurement of staff safety performance • Analysis and review of procedures • Safety data and trends provided to all staff

11. Fall Response • Evaluate and monitor resident for 72 hours after a fall • Investigate fall circumstances • Record circumstances • Alert primary care provider • Implement intervention in 24 hours • Complete Falls assessment • Develop plan of care • Monitor staff compliance and resident response

12. Data Collection and Analysis • Number of falls per month • Number of residents who fall each month • Number of residents with two or more falls per month • Number of falls with serious injury each month

13. Long Term Management • Screening process • Falls assessment • Fall intervention plan • Comprehensive care plan • Intensive care planning for residents with recurrent falls • Falls intervention monitor

14. Information and Training for Staff, Primary Care Providers, Residents and Families • Training facility staff • Information for primary care providers • Information for residents and their families

15. Living Space Inspection • Nursing List • Engineer List • Bed Safety • Supervision

16. Person Centered and Directed Care • Know your residents so well even if they cannot communicate • Restoring choices • One size does not fit all

17. Guidance About Person Centered and Directed Care • Review F242 Self-Determination and Participation • The regulation has always contained the following rights to make choices over: • Activities • Schedules • Health care • Interactions with members of the community • Aspects of his or her life that are significant to the resident • New language clarifies some of these choices • Intent adds language for home to actively seek resident preferences in order to help them fulfill their choices This content was taken from the Quality of Life and Environment Tag Changes, written by CMS Division of Nursing Homes Survey and Certification Group 3/02/2009.

18. Guidance About Person Centered and Directed Care • Review F246 Accommodation of Needs • Language added that facility should be accommodating NEEDS and preferences • Facility needs to assess both needs and preferences of each resident and accommodate to extent reasonable, so long as others are not endangered This content was taken from the Quality of Life and Environment Tag Changes, written by CMS Division of Nursing Homes Survey and Certification Group 3/02/2009.

19. Review F246 • Facility should furnish common areas with furniture that enhances residents’ abilities to maintain their independence in sitting down and arising, and should strive to accommodate residents of different heights through different sizes and types of seating choices • Note added to direct surveyors to Dignity and to Lighting for certain issues This content was taken from the Quality of Life and Environment Tag Changes, written by CMS Division of Nursing Homes Survey and Certification Group 3/02/2009.

20. Review F246 (Cont.) • Next par. stresses the concept of reasonableness and includes residents having needed items such as toiletries at hand, adaptive equipment added (door handle gripper) where needed, furniture arranged to accommodate needs and preferences • Last par. stresses staff interactions to accommodate visual and hearing deficits This content was taken from the Quality of Life and Environment Tag Changes, written by CMS Division of Nursing Homes Survey and Certification Group 3/02/2009.

21. Review F246 (Cont.) • Surveyors should observe residents in their rooms and in common areas and should interview residents to note if needs and preferences are being accommodated to the extent reasonable • Some specifics from the Guidance are covered as things to observe and ask about • Do outdoor smoking areas accommodate residents? This content was taken from the Quality of Life and Environment Tag Changes, written by CMS Division of Nursing Homes Survey and Certification Group 3/02/2009.

22. Resident preferences or past patterns form basis of decision making about some routines. Residents make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and lifelong habits. Staff consult residents or put themselves in residents’ place while making the decisions. Mgmt.makes most of the decisions with little conscious consideration of the impact on residents and staff. Staff begin to organize routines in order to accommodate resident preferences—articulated or observed. Staff organize their hours, patterns and assignments to meet resident preferences. Residents accommodate staff much of the time—but have some choices within existing routines and options. Residents accommodate staff preferences; are expected to follow existing routines. Continuum of Person-Directedness Low High Developed by Mary Tess Crotty, Genesis HealthCare Corp, based on the model by Susan Misiorski and Joanne Rader, distributed at the Pioneer Institutes, 2005.

23. In Summary • Be proactive • Refer to your State Operations Manual, AMDA Guidelines, and falls program • Improve the assessment process • Create detailed and accurate plans of care • Improve the overall care plan process

24. Contact Information: Mary Funseth mfunseth@metastar.com 608-441-8229 Jody Rothe jrothe@metastar.com 608-441-8271 MetaStar, Inc. 2909 Landmark Place Madison, WI 53713 800-362-2320 www.metastar.com This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.  9SOW-WI-PS-10-53.