Fall Prevention

1. Fall Prevention By Katie Compton Rebecca Collins Kati Schmitt Stephanie Shephard

2. Why is it Important Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable. 1 out of 3 adults age 65 and older falls each year Falls are the leading cause of injury, death and most non-fatal injuries leading to hospitalizations In 2008, over 19,700 older adults died from unintentional fall injuries The death rates from falls among older men and women have risen sharply over the past decade 78% are anticipated physiologic falls 14% of all falls in hospitals are accidental 8% are unanticipated physiologic falls

3. The Cost • One study found that in 2007 the average cost of a fall was $425 • In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries (This equals $28.2 billion in 2010 dollars) • Direct and indirect costs associated with back injuries in the healthcare industry are estimated to be $20 billion annually

4. Demographics • 23 Adult Family Homes in Port Orchard • 18 Adult Family Homes in Gig Harbor • 63 in Kitsap County • 2,831 In Washington State (Dec. 2011)

5. National Safety Goals • Reduce the rate of emergency department visits due to falls among older adults (Healthy People 2020) • Reduce Falls by 10% (Healthy People 2020) • Identify patient safety risks • NPSG.15.02.01 Find out if there are any risks for patients. For example patients who are on certain medications have a higher risk for falls. (Joint Commission Healthy Patient Goals, 2012) • Prevent patients from falling • NPSG.09.02.01 Find out which patients are most likely to fall. For example, is the patient taking any medicines that might make them weak, dizzy or sleepy? Take action to prevent falls for these patients (Joint Commission Healthy Patient Goals, 2012)

6. Fall Risk Factors • Above age of 65 • History of falls • Fear of falling • Cognitive and mood impairments • Dizziness • Functional impairments • Environmental hazards • Elimination problems • Medications

7. Fall Prevention Measures • Thorough assessment of patients mobility impairments • Remove throw rugs • Ensure stairways are well lit and repaired • Remove clutter from stairways and walkways • Install handrails wherever needed • Avoid use of unstable ladder and step-stools • Never attempt to do anything beyond reach or physical ability • Clean damp areas promptly

8. Fall Prevention Interventions • Muscle strengthening (Tai Chi, water aerobics) • Range of motion exercises • Gait and balance training • Medication review (especially for medications that cause postural hypotension) • Assistive devices (canes, walkers)

9. Caregiver Responsibilities • Promoting patient safety and security • Protecting patient from potential hazards • Anticipating and minimizing fall risk factors • Being familiar with nurse policies, proper procedures, and state regulations • Know the patient’s care plan

10. Care Plans Care planning is an essential part of healthcare, but is often misunderstood or regarded as a waste of time. Without a specific document depicting the plan of care, important issues are likely to be neglected. A negotiated care plan provides a "road map" of sorts, to guide all who are involved with a patient/resident's care.

11. Care Plans Continued From the assessment, the adult family home will develop a written negotiated care plan. The home must ensure each resident's negotiated care plan includes: • A list of the care and services to be provided • Identification of who will provide the care and services • When and how the care and services will be provided     • How medications will be managed, including how the resident will get their medications when the resident is not in the home • The resident's activities preferences and how the preferences will be met • Other preferences and choices about issues important to the resident, including, but not limited to:      (a) Food     (b) Daily routine     (c) Grooming     (d) How the home will accommodate the preferences and choices.

12. Care Plans Continued • If needed, a Care Plan can also be used to: • Follow in case of a foreseeable crisis due to a resident's assessed needs • Reduce tension, agitation and problem behaviors • Respond to resident's special needs • Respond to a resident's refusal of care or treatment • Identification of any communication barriers the resident may have and • How the home will use behaviors and nonverbal gestures to communicate with the resident • Statement of the ability for resident to be left unattended for a specific length of time • Hospice care plan

13. Assessments http://www.stanleyhealthcare.com/files/pdf/FallAssessmentToolGuidelines.pdf

14. Factors to Identify: Intrinsic • Previous fall - studies have cited a history of falls as a significant factor associated with patients being more likely to fall again. • Reduced vision – vision affected by, for example, a decline in visual acuity, decreased night vision, altered depth perception, decline in peripheral vision, or glare intolerance. • Unsteady gait - manner and style of walking. • Musculoskeletal system – impact from factors such as muscle atrophy, calcification of tendons and ligaments, and increased curvature of the spine (osteoporosis) are associated with ability to maintain balance and proper posture. • Mental status – status affected by confusion, disorientation, inability to understand, and impaired memory. • Acute illnesses – rapid onset of symptoms associated with seizures, stroke, orthostatic hypotension, and febrile conditions. • Chronic illnesses - conditions such as arthritis, cataracts, glaucoma, dementia, diabetes and Parkinsonism.

15. Factors to Identify: Extrinsic • Medications - those that affect the central nervous system, such as sedatives and tranquilizers, benzodiazepines, and the number of administered drugs. • Bathtubs and toilets – equipment without support, such as grab bars. • Design of furnishings – height of chairs and beds. • Condition of ground surfaces - floor coverings with loose or thick-pile carpeting, sliding rugs, upended linoleum or tile flooring, highly polished or wet ground surfaces. • Poor illumination conditions - intensity or glare issues. • Type and condition of footwear - ill-fitting shoes or incompatible soles such as rubber crepe soles, which, though slip resistant, may stick to linoleum floor surfaces. • Improper use of devices - bedside rails and mechanical restraining devices that may actually increase fall risk in some instances. • Inadequate assistive devices - walkers, wheelchairs and lifting devices.

16. Interventions for the Mobile Patient • Proper lighting • Nonskid footwear • Call bells • Reduce obstacles • Area rugs

17. Interventions for the Non-mobile Patient • Alarm systems bed alarms chair alarms mats Detour devices nets across doorways

18. Employee Interventions It’s Your Body! • Physically Fit • Proper shoes • Proper equipment • Proper Lifting Techniques

19. Equipment • Gait belt • Slide Boards • Maxi Slide Sheets • Lifts • Hoyer • Sarita • Sit to stand

20. Process/ Getting Equipment • Process • Pt consult • Resources for equipment • Hover-round • Depends on the limitations of the patient and what could assist them better

21. Gait Belts • How to put on https://www.youtube.com/watch?v=Q7JYO3K88rE • How to assist if they fall https://www.youtube.com/watch?v=M5mZyo6dCg

22. Lifts • Hoyer • Sit-to-Stand • Sarita http://www.youtube.com/watch?v=wRxp-BTIoQo http://youtu.be/M29JBWRcaLg

23. Transfers • Slide board • Slide Sheets • Hover Mats • Use the patients abilities to assist in the transfer • Proper body mechanics http://www.youtube.com/watch?v=PGFg50ay1Ac

24. Developing a Safety Program “Because patients fall in a variety of situations, and these falls are due to innumerable causes, there cannot be one routinized care plan to prevent falls. Although some prevention strategies are obvious and may be used with many patients, other patients present more of a challenge and demand creative and innovative solutions to ensure patient safety.”- Premeire.com Assessing and screening for risk factors for falls. Using incidents to implement a falls prevention protocol. Implementing protocols according to patient needs. Assessing and reassessing patient and modifying as appropriate. Reporting falls (internal and external). Measuring/monitoring fall rates. Improving the falls prevention program

25. What to do if a Patient Falls First and Fore most- • Assess for Injury • Notify • Document • Evaluate why the fall occurred and develop a plan to prevent further falls

26. What to do if you or an employee is injured from a transfer • Notify Employer • Seek medical attention • File necessary forms • Evaluate why the injury occurred • Plan to prevent further injuries

27. Case Study Betty Lou is a 72-year-old woman who has recently been admitted to your home. She has a history of diabetes and obesity and has recently been diagnosed with dementia. She has had 3 falls in the past month. She is insistent that she can live alone and often does not want your assistance with ADLs. She can become combative at times. She is on lorazapam PRN, gabapentin, metformin, sliding scale Novalog, aspirin & a daily MV. • What risk factors does B.L have? • What safety measures would be used for her?

28. Open Discussion • Do you have a time when you experienced unsafe situation when transferring a patient? • Have you suffered an injury? • What did you do when an injury occurred? • What do you do in your facility to prevent falls?

29. Resources Here are a list of websites that you can refer to: • https://www.wsrcc.org/ • https://www.premierinc.com/index.jsp

30. References Preventing Falls in Older People: Assessments and Interventions. Jones, David ; Whitaker, Tracy. Nursing Standard (NURS STAND), 2011 Aug 31-Sep 6; 25(52): 50-5 (24 ref) http://search.ebscohost.com.ezproxy.plu.edu/login.aspx?direct=true&db=c8h&AN=2011275166&site=ehost-live Interventions for the prevention of falls in older adults:systematic review and meta-analysis of randomised clinical trials. John T Chang, Sally C Morton, Laurence Z Rubenstein, Walter A Mojica, Margaret Maglione, Marika J Suttorp,Elizabeth A Roth, Paul G Shekellehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC381224/pdf/bmj32800680.pdf The costs of fatal and non-fatal falls among older adults. J A Stevens, P S Corso, E A Finkelstein, T R Miller. Injury Prevention 2006;12:290–295. doi: 10.1136/ip.2005.011015  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563445/pdf/290.pdf Preventing Disability and Falls in Older Adults: A Population-Based Randomized Trial. Edward H. Wagner, MD, MPH, Andrea Z. LaCroix, PhD, Lou Grothaus, MS, Suzanne G. Leveille, RN, MN, Juilia A. Hecht, PhD, Karen Artz, MS, Kristine Odle, MSW, and David M. Bluchner, MD, MPH. American Journal of Public Health. November 1994, Vol. 84. No. 11 http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.11.1800 Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test. Anne Shumway-Cook, Sandy Brauer and Marjorie Woollacott. PHYS THER. 2000; 80:896-903. http://physicaltherapyjournal.com/content/80/9/896.full.pdf+html National Council on Aging- Fall prevention programs. http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/ Falls in older people: epidemiology, risk factors and strategies for prevention. Laurence Z. Rubestein. Age and Ageing 2006; 35-S2: ii37–ii41 doi:10.1093/ageing/afl084ii37.http://ageing.oxfordjournals.org/content/35/suppl_2/ii37.full.pdf+html CDC- Older Adult Falls: An Overview: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html Healthy People 2020. http://healthypeople.gov/2020/about/DOHAbout.aspx Centers for Disease Control:http://blogs.cdc.gov/niosh-science-blog/2008/09/lifting/ Nursing World; Fall Prevention: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92