Presentation Transcript

1. Evaluating Falls

   CBC News Hour April 9, 2014 CBC Survey Unit
2. What’s the Problem? The CBC Survey Unit has cited C270—Evaluation and Monitoring—more frequently in the past year. It is often related to falls. We want to provide assistance to help facilities: Understand the rule; and Understand how the rule applies to changes of condition related to falls. So let’s address this…
3. Let’s Look at a Fall Logically Forget we deal with “residents”. Let’s suppose your mother has fallen. What would you do? Evaluate your mother to determine if she is alright. Give or get care as needed. Keep checking on her. Try to determine why your mother fell. Figure out what to do so your mother won’t fall in the future. Check on your mother to make sure your ideas are keeping her safe.
4. What Facilities are Doing After a resident falls, this is typically what we see: Facilities are doing an “immediate” evaluation of the resident: Taking vitals Checking for wounds Evaluating pain Checking ROM
5. What Facilities are Doing And facilities are typically determining immediate interventions: Determining if a hospital visit is required Initiating “Alert Charting” to monitor the resident Notifying family and physician And some facilities try to identify factors that could have contributed to the fall: “Didn’t use her walker” “Had a UTI”
6. Evaluating the Fall Facilities often fail to evaluate why the person fell. Evaluating means gathering information and asking questions. What did the resident or staff say? What did the staff observe? Have there been any recent changes?
7. Interventions Once you’ve identified how or why the resident fell, you will want to develop and implement some interventions. Think about interventions you might use… New interventions need to be documented and communicated to staff.
8. An Example Our resident—Mr. Smith—had two falls. We developed the following interventions: Remind Mr. Smith to use his walker; and Remind Mr. Smith to call the CGs for assistance. This seemed to work for a couple of weeks. But this week, Mr. Smith has been falling again.
9. Repeated Falls—What Next? Now, your evaluation of the repeated falls becomes a little more complex: You still have to evaluate why the person fell again: Same reasons? New issue? Were staff following the service plan? And evaluate the previous interventions: Were they effective? Do we need new interventions?
10. Implemented/Followed? Staff documentation and follow-up interviews should tell you whether the interventions were being implemented and followed. If not, is it an issue with: Staff training? Communication of care needs? (Staff didn’t review the service plan) Inadequate staffing to meet the needs of the residents?
11. Adequate? Staff documentation and follow-up interviews should evaluate whether the existing interventions are effective in preventing re-occurrence. If not, you would develop additional interventions. Let’s return to Mr. Smith…
12. We Re-Evaluate Through the information we gathered from staff, we discovered that Mr. Smith just can’t remember to use his walker or call CGs for assistance. What now? We will develop and implement some new interventions: for example More frequent checks; Visual reminders; Med review; Physical Therapy; Etc
13. 3.MONITORING Evaluate whether interventions are being Implemented and are effective 1.EVALUATE/RE-EVALUATE Why did the resident fall? 2. INTERVENTIONS We know why the resident fell, what are we going to do about it? Re-Evaluation and Monitoring
14. Summary When an incident, such as a fall, occurs: Evaluate to find out why the resident fell; Determine whether or not the service plan was being followed; Evaluate whether interventions need to be developed; Communicate interventions to staff; and Monitor that the service plan is being implemented, and re-evaluate that the new interventions are effective.
15. Questions? Thanks! David.e.mackowski@state.or.us Kristina.e.anderson@state.or.us