1 / 34

FALL PREVENTION & RESIDENT SAFETY

FALL PREVENTION & RESIDENT SAFETY. RISK IDENTIFICATION, ASSESSMENT & THE FALLS PROGRAM Nursesharks for CCRX Pharmacy author-Alice B. Levy RN, BS, CWOCN. OBJECTIVES. 1.UNDERSTAND THE RISK FACTORS FOR FALLS IN THE ELDERLY

nowles
Download Presentation

FALL PREVENTION & RESIDENT SAFETY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FALL PREVENTION & RESIDENT SAFETY RISK IDENTIFICATION, ASSESSMENT & THE FALLS PROGRAM Nursesharks for CCRX Pharmacy author-Alice B. Levy RN, BS, CWOCN

  2. OBJECTIVES 1.UNDERSTAND THE RISK FACTORS FOR FALLS IN THE ELDERLY 2. UNDERSTAND THE RISKS OF INJURY ASSOCIATED WITH FALLS IN THE ELDERLY 3. BE AWARE OF HOW FALLS ARE DEFINED 4. BE ABLE TO PERFORM A RISK ASSESSMENT FOR FALLS BOTH POST FALL AND ONGOING 5. BE ABLE TO IDENTIFY CONTRIBUTING FACTORS TO FALLS IN THE ELDERLY 6. IDENTIFY DRUG RELATED SIDE EFFECTS WHICH CAN CONTRIBUTE TO FALLS 7. BE ABLE TO DEVELOP A FALLS PREVENTION PROGRAM 8. BE ABLE TO DO ONGOING INVESTIGATION & TRENDING

  3. STATISTICAL DATA • 30-40% OF COMMUNITY BASED ELDERLY FALL • 50% OF FALLS IN ELDERLY POPULATION OCCUR IN HOSPITALS OR NURSING HOMES • YOUNG CHILDREN AND ATHLETES FALL MORE OFTEN BUT WITH INFREQUENT INJURY • 20-30% OF FALLS IN THE ELDERLY RESULT IN SERIOUS, LIFE-CHANGING INJURY WHICH CAN INCREASE ANXIETY, DEPRESSION, AND SOCIAL ISOLATION, AS WELL AS RESTRICTING MOBILITY • THE INCIDENCE OF FALLS RISES AS ONE APPROACHES MIDDLE AGE AND PEAKS AT 75-80 YEARS OF AGE • 2/3 OF ELDERLY WHO FALL, FALL AGAIN IN 6 MONTHS • WOMEN HAVE GREATER INCIDENCE OF FALLS

  4. RISK FACTORS • ADMISSION TO A LONG TERM CARE FACILITY IMMEDIATELY PLACES THE ELDERLY PERSON AT RISK • IF A FALL HAS OCCURRED, THE ELDERLY PERSON IS LIKELY TO FALL AGAIN • THERE ARE BOTH INTRINSIC AND EXTRINSIC RISK FACTORS • THE RISK FOR FALLS INCREASES AS THE NUMBER OF RISK FACTORS INCREASE • THE RELATIONSHIP BETWEEN RISK FACTORS IS MORE SIGNIFICANT THAN THE INDIVIDUAL RISK FACTORS IN THE ELDERLY

  5. RISK FACTORS • INTRINSIC RISK FACTORS: ADVANCED AGE>80 MUSCLE WEAKNESS GAIT & BALANCE DIFFICULTY ARTHRITIC CHANGES OSTEOPOROSIS* DECLINE IN ACTIVITIES OF DAILY LIVING SLOWING OF REFLEXES LACK OF PHYSICAL ACTIVITY* DECREASED COGNITION DEPRESSION VISUAL IMPAIRMENT* COMORBID MEDICAL DIAGNOSESE

  6. RISK FACTORS • EXTRINSIC RISK FACTORS: ENVIRONMENTAL FACTORS OBSTRUCTIONS IN PATH POOR LIGHTING, SLIPPERY SURFACES MATTRESS OVERLAYS FOR WOUNDS MEDICATION SIDE EFFECTS DIZZINESS, VERITGO, SYNCOPE BRADYCARDIA, POSTURAL HYPOTENSION CONFUSION

  7. RISK FACTORS • SITUATIONAL: RUNNING TO THE BATHROOM REACHING TO TURN OFF AN ALARM NOT BEING FULLY AWAKE UNFAMILIAR ENVIRONMENT BUMPING INTO OBJECTS BEING BUMPED BY OBJECT OR OTHER INDIVIDUAL

  8. FALLS AND INJURY • UNINTENTIONAL INJURY IS 5TH LEADING CAUSE OF DEATH IN ELDERLY • BECAUSE OF SLOWER REFLEXES, THE ELDERLY OFTEN RECEIVE FACIAL INJURIES DURING A FALL • INJURIES INCURRED DURING A FALL CAN SEVERELY DECREASE PHYSICAL FUNCTIONING AND SUBSEQUENTLY AFFECT THE QUALITY OF LIFE FOR THE INDIVIDUAL

  9. FALLS DEFINED ACCORDING TO THE MERCK MANUEL OF GERIATRICS AND THE DEPARTMENT OF HEALTH: A FALL IS ANY DROP FROM A HIGHER TO A LOWER POSITION

  10. COMPONANTS OF A RISK ASSESSMENT • REVIEW PAST FALLS • REVIEW PREVIOUSLY MENTIONED RISK FACTORS • COMPLETE A HISTORY AND PHYSICAL • SCREEN ROUTINELY; I.E. WHEN MDS DUE • TRACK AND REVIEW THE CIRCUMSTANCES SURROUNDING EACH FALL • REVIEW MEDICATION CHANGES • REVIEW NEED FOR ALARMS OR OTHER DEVICES • DISCOURAGE THE USE OF RESTRAINTS

  11. POST FALL ASSESSMENT • VITAL SIGNS AND IMMEDIATE PHYSICAL ASSESSMENT BY RN (INCLUDE OTHOSTATIC BPS, TEMP) • DETAILS FROM ANY WITNESSES • DETAILS FROM RESIDENT • ENVIRONMENTAL FACTORS (LIGHTING, OBSTRUCTIONS TO MOVEMENT) • CHANGES IN FUNCTIONAL STATUS • MEDICATION CHANGES • INTENT THAT CAUSED FALL (GOING TO BATHROOM, REACHING FOR ITEM ON FLOOR)

  12. ONGOING ASSESSMENTS • TRACK RECURRENT FALLS • DETERMINE SHIFT OR TIME OF DAY TRENDS • DETERMINE TRENDS R/T CAREGIVER • REVIEW MEDICATION ADMINISTRATION TIMES R/T FALLS • DETERMINE RELATIONSHIP TO ILLNESS OR SIGNIFICANT CHANGE

  13. ADDITIONAL POST FALL INFORMATION • RESIDENT DID NOT USE ASSISTIVE DEVICE • RESIDENT LOST BALANCE • RESIDENT LOST CONSCIOUSNESS • RESIDENT WAS DIZZY BEFORE OR DURING FALL • RESIDENT HAD DIFFICULTY SEEING WHERE HE/SHE WAS GOING • RESIDENT WAS CONFUSED AT TIME OF THE FALL • RESIDENT WAS NEW TO THE ENVIRONMENT (NEW RESIDENT OR ROOM CHANGE) • RESIDENT HAD BEEN GIVEN A LAXITIVE OR DIURETIC PRIOR TO THE FALL • RESIDENT DID NOT HAVE CALL BELL IN REACH

  14. OTHER CONTRIBUTORY CONSIDERATIONS R/T FALLS • DIABETES: 1.PERIPHERAL NEUROPATHY-CAN’T FEEL FOOT PLACEMENT, PAINFUL FEET, DEFORMITIES MAKING WALKING DIFFICULT, DIABETIC FOOT ULCERS 2. RETINOPATHY-VISUAL DECLINE 3. AUTONOMIC NEUROPATHY- ORTHOSTATIC HYPOTENSION 4. HYPOGLYCEMIC EVENT-LOSS OF CONSCIOSNESS 5. HYPERGLYCEMIC POLYURIA-NEED TO URINATE QUICKLY

  15. OTHER CONTRIBUTORY CONSIDERATIONS R/T FALLS • EFFECTS OF MEDICATIONS 1. DECLINE IN ELDERLY-GI, HEPATIC & RENAL FAILURE 2. FRAIL ELDERLY OFTEN HAVE MULTI- SYSTEM DECLINE 3. POLYPHARMACY IN ELDERLY 4. DRUG ACCUMULATION 5. DRUG INDUCED DELERIUM AS OPPOSED TO DEMENTIA

  16. SIDE EFFECTS OF DRUGS R/T FALLS BENZODIAZEPINES (ATIVAN, XANAX), NARCOTICS, NEUROLEPTICS, ANY DRUG WITH ANTICHOLINERGIC EFFECTS (TRYCYCLIC ANTIDEPRESSENTS & SIME INCONTINENCE DRUGS-OXYBUTININE) CAN CAUSE COGNITIVE IMPAIRMENT & CONFUSION

  17. SIDE EFFECTS OF DRUGS R/T FALLS ANTICONVULSANTS, ANTIDEPRESSENTS, BENZODIAZAPINES, NARCOTICS, NEUROLEPTICS(ANTIPSYCHOTICS); CAN CAUSE DIZZINESS, ORTHOSTATIC HYPOTENSION, SEDATION, DROWSINESS BETA BLOCKKERS, NITRATES, VASODILATORS; CAN CAUSE SYNCOPE ANTICONVULSANTS, BENZODIAZEPINES, NEUROLEPTICS; CAN CAUSE BALANCE PROBLEMS

  18. SIDE EFFECTS OF DRUGS R/T FALLS ANTIDEPRESSENTS,METOCLOPRAMIDE (REGLAN), NEUROLEPTICS ; CAN CAUSE ABNORMALITIES OF GAIT ANTIHYPERTENSIVES ; CAN CAUSE ORTHOSTATIC HYPOTENSION ANTIARRHYTHMICS; CAN CAUSE ARRYTHMIAS DIURETICS; CAN INCREASE URGENCY

  19. SIDE EFFECTS OF DRUGS R/T FALLS NEUROLEPTICS & ANY DRUG WITH ANTICHOLINERGIC EFFECTS CAN CAUSE VISUAL DISTURBANCES ANTIDEPRESSENTS,(SSRI, TRICYCLICS) NEUROLEPTICS, STIMULANTS, CAFFIENE CAN INCREASE AGITATION

  20. PROCESSES FOR PREVENTION EXERCISE TRAINING 1.IMPROVES STRENGTH AND BALANCE 2.WEIGHT BEARING TO DECREASE RISK FOR FRACTURE 3.DO AS AN ACTIVITY TO INCREASE PSYCHOLOGICAL WELL BEING 4. TEACH MOVEMENT IN STEPS AND GOOD SAFETY AWARENESS 5. CONTINUE WITH EFFECTIVE RESTORATIVE & MAINTENANCE PROGRAMING

  21. PROCESSES FOR PREVENTION MEDICATION INTERVENTION 1. CALCIUM, VITAMIN D, FOSOMAX, HORMONE REPLACEMENT IN TREATMENT OF OSTEOPOROSIS 2. MANAGING GLYCEMIC MEDICATIONS AND DIET FOR DIABETICS 3. MANAGING PSYCHOTROPHIC MEDICATIONS AND SIDE EFFECTS 4. CARDIOVASCULAR MEDICATIONS AND/OR PACEMAKER

  22. PROCESSES FOR PREVENTION MEDICATIONS PERIODIC PHYSICIAN REVIEW FOR: POLYPHARMACY SIDE EFFECTS ADMINISTRATION TIME AND WAKEFULNESS/URINATION ALLERGIES DELERIUM

  23. PROCESSES FOR PREVENTION MANAGING DECLINING VISION 1. ROUTINE VISION TESTING 2. USING CONTRASTING COLORS IN HANDRAILS, WALKWAYS ETC. 3. EFFECTIVE LIGHTING IN RESIDENT ROOMS 4. KEEPING GLASSES CLEAN AND ACCESSABLE

  24. PROCESSES FOR PREVENTION CONSIDER CONDITION CHANGES: 1. MONITER LABS-CBC, GLUCOSE, HGB A1C, ELECTROLYTES 2. CHANGES IN DISEASE STATUS & MEDICATION CHANGES-WORSENING GAIT IN PARKINSONS DISEASE 3. WORSENING PAINFUL MOVEMENT IN ARTTHRITIC CONDITIONS OR OSTEOPOROSIS (PRONE TO PATHOLOGICAL FRACTURE THAT MAY CAUSE FALL) 4. NEW ONSET FEVER, INFECTION

  25. PROCESSES FOR PREVENTION CONSIDER CONDITION CHANGES: 5. ORTHOSTATIC BP DROP CAUSED BY NEW MEDICATION, CHANGE IN CARDIOVASCULAR STATUS 6. MONITER O2 LEVELS FOR CONFUSION, LOSS OF CONSCIOUSNESS R/T HYPOXIA 7. MONITER APICAL PULSE FOR CHANGES IN RATE/RHYTHM OF HEART 8. CONSIDER A UTI IF MENTAL STATUS CHANGE AND/OR WEAKNESS (FALL MAY BE ONLY SX OF UTI)

  26. PROCESSES FOR PREVENTION LOOK AT THE ENVIRONMENT: LIGHTING CLUTTER FLOORS & MATS THRESHHOLDS & UNEVEN SURFACES HEIGHT OF CHAIRS/TOILET SEATS HEIGHT OF BED ITEMS WITHIN REACH EXCESSIVE DISTRACTING NOISE

  27. PROCESSES FOR PREVENTION ASSISTIVE DEVICES: WALKERS, CANES, WHEELCHAIRS MERRYWALKERS HANDRAILS SPECIALTY FOOTWEAR HIP PROTECTORS ALARMS? ASSISTIVE OR CAUSE AGITATION? RESTRAINTS DO NOT PREVENT FALLS INCLUDING SIDE RAILS

  28. ONGOING SUPPORT AND FOLLOW THROUGH MUST HAVE AN EFFECTIVE PROCESS TO EVALUATE IMMEDIATELY, WHEN THE FALL OCCURS, AND ONGOING, TO DETERMINE TRENDS FOR POSSIBLE RECURRENCE

  29. F/U ONGOING KEEP TRACK OF REPORTS ON FALLS AND AUDIT FOR IMMMEDIATE REPONSE FOR INTERVENTIONS WEEKLY MEETINGS TO INCLUDE NURSING STAFF INCLUDING AIDS, THERAPY AND RESTORATIVE, RNAC OR MDS COORDINATOR; MEDICAL DIRECTOR, RESIDENT AND/OR FAMILY MAY ALSO BE BENEFICIAL CONSIDER USE OF ALARMS, CORRECT PLACEMENT AND RESPONSE TO (INCLUDING HOW RESIDENT REACTS)

  30. INVESTIGATION AND TRENDING BASIC INFORMATION FOR TRENDING: TIME OF DAY DAY OF WEEK HALL OR WING CNA ASSIGNMENT PRESENCE OF TOILETING DEPENDENCE AND PROGRAMS IN PLACE FUNCTIONING AND USE/MISUSE OF ALARMS USE/DAMAGE OF ASSISTIVE DEVICES

  31. FALLS ARE EVERYONE’S RESPONSIBILITY INVOLVE THE WHOLE TEAM *INCLUDE THE RESIDENT *AVOID INJURY *BE AWARE OF CHANGES IN THE RESIDENT *BE AWARE OF ENVIRONMENTAL CHANGE

  32. ASK FOR HELP PARRI PENNSYLVANIA RESTRAINT REDUCTION INITIATIVE DEVELOPED WITH CMS AND IS A PROGRAM O KENDAL OUTREACH, LLC

  33. REFERENCES • RIEFKOHL, ELSARIS Z., PHARMD;ET AL. MEDICATIONS AND FALLS IN THE ELDERLY: A REVIEW OF THE EVIDENCE AND PRACTICAL CONSIDERATIONS. P&T, NOVEMBER 2003,VOL28.NO.11;724-733 • TREMBLAY, K.R.JR., AND BARBER, C.E. PREVENTING FALLS IN THE ELDERLY, NO. 10.242, COLORADO STATE UNIVERSITY;WWW.EXT.COLOSTATE.EDU/PUBS/CONSUMER/10242.HML • AMERICAN GREIATRICS SOCIETY, BRITISH GERIATRICS SOCIETY, AND AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS PANEL ON FALLS PREVENTION. GUIDELINE FOR THE PREVENTION OF FALLS IN OLDER PERSONS.JAGS 49:664-672, 2001 • CDC INJURY CENTER. FALLS IN NURSING HOMES FACT SHEET. 2/19/2009; WWW.CDC.GOV/NCIPC/FACTSHEETS/NURSING.HTM

  34. REFERENCES 5. MAURER, MATHEW S., BURCHAM, JOYCE AND HUAI CHENG. DIABETES MELLITUS IS ASSOCIATED WITH AND INCREASED RISK OF FALLS IN ELDERLY RESIDENTS OF A LONG-TERM CARE FACILITY. THE JOURNALS OF GERONTOLOGY SERIES A: BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 60:1157-1162(2205) THE GERONTOLOGICAL SOCIETY OF AMERICA 6. FALLS, THE MERCK MANUEL OF GERIATRICS, CHAPTER 20, SECTION 2; WWW.MERCK.COM/MKGR/MMG/SEC2/CH20/CH20A.JSP 7. RUDDOCK, BRENT. MEDICATIONS AND FALLS IN THE ELDERLY. DRUG INFORMATION AND RESEARCH CENTER, CPJ/RPC, JULY/AUGUST 2004, VOL. 137, NO. 6 8. CRITERIA FOR URINARY TRACT INFECTION IN THE ELDERLY, ONLINE CME FROM MDESCAPE; WWW.MEDSCAPE.COM/VIEWARTICLE/481627_2 9. HTTP:PARRI.KENDALOUTREACH.ORG/CONTACT.ASPX

More Related