DECREASING FALLS

IN

LONG-TE

RM CARE

INTRODUCTIONFalls in a long-term care facility is a very common problem. Approximately 1800 residents will die as a result from a fall.10-20% suffer a serious injury and 2-6% suffers a fracture.Long-term care residents are twice as likely as an elderly

individual living in the community to suffer a fall. (CDC, 2012).

Falls are preventable!!

WHO’S AT RISK?• Diagnosis of Parkinson’s, Dementia or Alzheimer’s.• Poor vision.• Decreased mobility and increased weakness.• Residents with incontinence of bowel and bladder or both.• Residents who have pain.• Residents who take medications such as: hypnotics, narcotics, antiseizure

and antihypertensives.• Orthostatic hypotension can also increase a risk for falls. (CDC, 2012).

The next slide shows the Fall Risk Assessment form used to determine the patient’s risk for falling.

_____________________________________________________________ (Name of Facility)

Fall Risk Assessment Form

Resident's Name: Physician:

Examiner

Assessment Date

PARAMETER SCORE RESIDENT STATUS/CONDITION Enter Evaluation Score Below

A. Level of

Consciousness/ Mental Status

0 ALERT (oriented X 3) OR COMATOSE

2 DISORIENTED X 3 at all times

4 INTERMITTENT CONFUSION

B. History of Falls (past 3 months)

0 NO FALLS in past 3 months

2 1 - 2 FALLS in past 3 months

4 3 OR MORE FALLS in past 3 months

C. Ambulation/ Elimination

Status

0 AMBULATORY/CONTINENT

2 CHAIR BOUND - Requires restraints and assist with elimination

4 AMBULATORY/INCONTINENT

D. Vision Status

0 ADEQUATE (with or without glasses)

2 POOR (with or without glasses)

4 LEGALLY BLIND

E. Gait/Balance

To assess the resident's Gait/Balance, have him/her stand on both feet without holding onto anything; walk straight forward; walk through a doorway; and make a turn.

0 Gait/Balance normal

1 Balance problem while standing

1 Balance problem while walking

1 Decreased muscular coordination

1 Change in gait pattern when walking through doorway

1 Jerking or unstable when making turns

1 Requires use of assistive devices (i.e., cane, w/c, walker, furniture)

F. Systolic Blood Pressure

0 NO NOTED DROP between lying and standing

2 Drop LESS THAN 20 mm Hg between lying and standing

4 Drop MORE THAN 20 mm Hg between lying and standing

G. Medications

Respond below based on the following types of medications: Anesthetics, Antihistamines, Antihypertensives, Antiseizure, Benzodiazepines, Cathartics, Diuretics, Hypoglycemics, Narcotics, Psychotropics, Sedatives/Hypnotics.

0 NONE of these medications taken currently or within last 7 days

2 TAKES 1 - 2 of these medications currently and/or within

last 7 days

4 TAKES 3 - 4 of these medications currently and/or within last 7 days

1 If resident has had a change in medications and/or change in dosage in the past 5 days = score 1 additional point

H. Predisposing Diseases

Respond below based on the following predisposing conditions: Hypotension, Vertigo, CVA, Parkinson's disease, Loss of limb(s), Seizures, Arthritis, Osteoporosis, Fractures.

0 NONE PRESENT

2 1 - 2 PRESENT

4 3 OR MORE PRESENT

Total score of 10 or above represents HIGH RISK TOTAL SCORE:

NURSING PROCESS FOR DECREASING FALLSAssessment: Is this resident at risk for falls? I’ll use the Fall

Risk form to find out.Diagnosis: The resident is at risk for falls!!!Plan: We need to do whatever we can to prevent a fall. Implement:: Let’s show the resident how to use the call-light

for help.Evaluation: The resident is able to use the call-light effectively

and ask for help.(Nursing Process, 2011).

DemographicsThose born between

1946-1964.Fasting growing group.60% in this group will

have at least 1 chronic condition by the year 2030.

GoalsTo improve the lives of

the older adult.Preventing injuries to the

older adult.Improving the older

adults’ quality of life.(Healthy People,2010).

HEALTHY PEOPLE 2020 GOALS

WHAT NURSING LEADERS CAN DO………….**OPTIMAL ASSESSMENT: AT RISK ASSESSMENTS, PROMOTE CRITICAL THINKING AND EDUCATION.** TARGETED CARE MANDATES: SIMPLIFY PROTOCOLS, MAKE URGENT INTERVENTIONS FIRST PRIORITY.**360 DEGREE SUPPORT: ALLOW PATIENT AND FAMILIES TO HAVE POWER, USE POINT-OF-CARE STAFF SUPPORT, INSTITUTE BEDSIDE REPORTING.** BE INNOVATIVE: USE VIDEO MONITORING EQUIPMENT, ALARMS, CORDLESS CALL LIGHTS. (Mosby’s, 2010).

TYPES OF EQUIPMENT TO USE FOR REDUCING FALLS:-Pressure alarms that alert staff to a resident getting up

unassisted.-Front and rear wheelchair anti-tippers.-Automatic brakes for those residents who forget to lock their

brakes.-Wheelchair brake extender handles.-Dycem mats for residents who slouch or slide to the edge of

their wheelchair.-Scoop mattresses for those who like to sleep on the edge of

their bed.-Non-skids strips placed on smooth surfaces.-Wedge cushions to help keep a resident from slouching in their

wheelchairs.-”Grabbers” so that residents do not have to reach too far to

get items.(Medine, 2011).

INNOVATIVE IDEAS-Use your imagination. Put yourself in that resident’s position

and see what they were looking at when they fell. Were they reaching for something they could not reach?

-Tailor your suggestions to the resident’s needs. Do they need a brightly colored call light they can see easier? Is their pathway clear of any obstacles? Do their clothing fit properly?

-Ask other staff for input. Sometimes you need a 2nd set of eyes? Ask your resident for their input.

-Educate, educate, educate!!

Hmmmm…………..??? I wonder???

-Assume everyone in the long-term care facility is at risk. Being in a new environment is a risk.

-Educate all immediately.-Put a care plan in place with

interventions clearly written.-Identify problem areas

immediately.-Keep the resident and the

family in the loop with any changes.

-Get all departments involved in identifying fall risks.

PROPOSED SOLUTION TO REDUCING FALLS

CONTRIBUTIO

NS TO

HEALTHCARE D

ELIVERY

SYSTEM-Decrease in falls.-Decrease in hospital stays.-Decrease in injuries.-Decrease in unnecessary expenses.-Decrease in fatalities and serious

injuries.-Increase in quality of life.-Increase in resident independence.(CDC, 2012).

FORMULATION OF A HEALTH POLICYMost long-term care facilities have a health policy in place for falls.There needs to be increased education among the staff to ensure

familiarity with all identified risks and interventions.Staff accountability for those who do not follow protocol. They need to

have disciplinary actions for not using the proper equipment they have been trained on.

Possible incentives for reducing falls within a facility would possibly keep the rate of falls down.

Facilities can increase budgets if needed to accommodate new state of the art monitoring equipment.

REFERENCESCenters for Disease Control and Prevention. (2012). Falls in nursing homes. Retrieved from www.cdc.gov/homeand

recreationalsafety/falls/nursing.html

Health People 2020. (2012). Older adults. Retrieved

from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=31

Medline Equipment Catalog. (2011). Adaptive equipment fall prevention

Mosby’s Nursing Suite. (2010). Nursing takes the lead: nurses have a big role in preventing “never events”

Retrieved from http://confidenceconnected.com/connect/article/nursing_takes_t

he_lead_nurses_have_a_big_role_in_preventing_never_even/