FALL PREVENTION & RESIDENT SAFETY RISK IDENTIFICATION, ASSESSMENT & THE FALLS PROGRAM Nursesharks...

FALL PREVENTION & FALL PREVENTION & RESIDENT SAFETYRESIDENT SAFETY

RISK IDENTIFICATION, ASSESSMENT RISK IDENTIFICATION, ASSESSMENT & THE FALLS PROGRAM & THE FALLS PROGRAM

Nursesharks for CCRX Pharmacy author-Alice B. Nursesharks for CCRX Pharmacy author-Alice B. Levy RN, BS, CWOCNLevy RN, BS, CWOCN

OBJECTIVESOBJECTIVES

1.UNDERSTAND THE RISK FACTORS FOR FALLS IN THE 1.UNDERSTAND THE RISK FACTORS FOR FALLS IN THE ELDERLYELDERLY

2. UNDERSTAND THE RISKS OF INJURY ASSOCIATED WITH 2. UNDERSTAND THE RISKS OF INJURY ASSOCIATED WITH FALLS IN THE ELDERLYFALLS IN THE ELDERLY

3. BE AWARE OF HOW FALLS ARE DEFINED3. BE AWARE OF HOW FALLS ARE DEFINED

4. BE ABLE TO PERFORM A RISK ASSESSMENT FOR FALLS 4. BE ABLE TO PERFORM A RISK ASSESSMENT FOR FALLS BOTH POST FALL AND ONGOINGBOTH POST FALL AND ONGOING

5. BE ABLE TO IDENTIFY CONTRIBUTING FACTORS TO FALLS IN 5. BE ABLE TO IDENTIFY CONTRIBUTING FACTORS TO FALLS IN THE ELDERLYTHE ELDERLY

6. IDENTIFY DRUG RELATED SIDE EFFECTS WHICH CAN 6. IDENTIFY DRUG RELATED SIDE EFFECTS WHICH CAN CONTRIBUTE TO FALLSCONTRIBUTE TO FALLS

7. BE ABLE TO DEVELOP A FALLS PREVENTION PROGRAM7. BE ABLE TO DEVELOP A FALLS PREVENTION PROGRAM

8. BE ABLE TO DO ONGOING INVESTIGATION & TRENDING8. BE ABLE TO DO ONGOING INVESTIGATION & TRENDING

STATISTICAL DATASTATISTICAL DATA

30-40% OF COMMUNITY BASED ELDERLY FALL30-40% OF COMMUNITY BASED ELDERLY FALL 50% OF FALLS IN ELDERLY POPULATION OCCUR IN 50% OF FALLS IN ELDERLY POPULATION OCCUR IN

HOSPITALS OR NURSING HOMESHOSPITALS OR NURSING HOMES YOUNG CHILDREN AND ATHLETES FALL MORE OFTEN BUT YOUNG CHILDREN AND ATHLETES FALL MORE OFTEN BUT

WITH INFREQUENT INJURYWITH INFREQUENT INJURY 20-30% OF FALLS IN THE ELDERLY RESULT IN SERIOUS, 20-30% OF FALLS IN THE ELDERLY RESULT IN SERIOUS,

LIFE-CHANGING INJURY WHICH CAN INCREASE ANXIETY, LIFE-CHANGING INJURY WHICH CAN INCREASE ANXIETY, DEPRESSION, AND SOCIAL ISOLATION, AS WELL AS DEPRESSION, AND SOCIAL ISOLATION, AS WELL AS RESTRICTING MOBILITYRESTRICTING MOBILITY

THE INCIDENCE OF FALLS RISES AS ONE APPROACHES THE INCIDENCE OF FALLS RISES AS ONE APPROACHES MIDDLE AGE AND PEAKS AT 75-80 YEARS OF AGEMIDDLE AGE AND PEAKS AT 75-80 YEARS OF AGE

2/3 OF ELDERLY WHO FALL, FALL AGAIN IN 6 MONTHS2/3 OF ELDERLY WHO FALL, FALL AGAIN IN 6 MONTHS WOMEN HAVE GREATER INCIDENCE OF FALLSWOMEN HAVE GREATER INCIDENCE OF FALLS

RISK FACTORSRISK FACTORS

ADMISSION TO A LONG TERM CARE FACILITY ADMISSION TO A LONG TERM CARE FACILITY IMMEDIATELY PLACES THE ELDERLY PERSON AT IMMEDIATELY PLACES THE ELDERLY PERSON AT RISKRISK

IF A FALL HAS OCCURRED, THE ELDERLY PERSON IF A FALL HAS OCCURRED, THE ELDERLY PERSON IS LIKELY TO FALL AGAINIS LIKELY TO FALL AGAIN

THERE ARE BOTH INTRINSIC AND EXTRINSIC RISK THERE ARE BOTH INTRINSIC AND EXTRINSIC RISK FACTORSFACTORS

THE RISK FOR FALLS INCREASES AS THE NUMBER THE RISK FOR FALLS INCREASES AS THE NUMBER OF RISK FACTORS INCREASEOF RISK FACTORS INCREASE

THE RELATIONSHIP BETWEEN RISK FACTORS IS THE RELATIONSHIP BETWEEN RISK FACTORS IS MORE SIGNIFICANT THAN THE INDIVIDUAL RISK MORE SIGNIFICANT THAN THE INDIVIDUAL RISK FACTORS IN THE ELDERLYFACTORS IN THE ELDERLY


INTRINSIC RISK FACTORS:INTRINSIC RISK FACTORS:ADVANCED AGE>80ADVANCED AGE>80MUSCLE WEAKNESSMUSCLE WEAKNESS

GAIT & BALANCE DIFFICULTYGAIT & BALANCE DIFFICULTY ARTHRITIC ARTHRITIC CHANGES CHANGES OSTEOPOROSIS*OSTEOPOROSIS*DECLINE IN ACTIVITIES OF DAILY LIVINGDECLINE IN ACTIVITIES OF DAILY LIVINGSLOWING OF REFLEXESSLOWING OF REFLEXES LACK LACK OF PHYSICAL ACTIVITY*OF PHYSICAL ACTIVITY* DECREASED DECREASED COGNITIONCOGNITION DEPRESSION DEPRESSION

VISUAL IMPAIRMENT* VISUAL IMPAIRMENT* COMORBID MEDICAL COMORBID MEDICAL

DIAGNOSESEDIAGNOSESE


EXTRINSIC RISK FACTORS:EXTRINSIC RISK FACTORS:ENVIRONMENTAL FACTORSENVIRONMENTAL FACTORS

OBSTRUCTIONS IN PATHOBSTRUCTIONS IN PATHPOOR LIGHTING, SLIPPERY SURFACES POOR LIGHTING, SLIPPERY SURFACES MATTRESS OVERLAYS FOR WOUNDS MATTRESS OVERLAYS FOR WOUNDS

MEDICATION SIDE EFFECTSMEDICATION SIDE EFFECTSDIZZINESS, VERITGO, SYNCOPEDIZZINESS, VERITGO, SYNCOPEBRADYCARDIA,BRADYCARDIA,POSTURAL HYPOTENSIONPOSTURAL HYPOTENSIONCONFUSIONCONFUSION


SITUATIONAL:SITUATIONAL:RUNNING TO THE BATHROOMRUNNING TO THE BATHROOM

REACHING TO TURN OFF AN REACHING TO TURN OFF AN ALARMALARMNOT BEING FULLY AWAKENOT BEING FULLY AWAKEUNFAMILIAR ENVIRONMENTUNFAMILIAR ENVIRONMENTBUMPING INTO OBJECTSBUMPING INTO OBJECTSBEING BUMPED BY OBJECT OR OTHER BEING BUMPED BY OBJECT OR OTHER

INDIVIDUALINDIVIDUAL

FALLS AND INJURYFALLS AND INJURY

UNINTENTIONAL INJURY IS 5UNINTENTIONAL INJURY IS 5THTH LEADING LEADING CAUSE OF DEATH IN ELDERLYCAUSE OF DEATH IN ELDERLY

BECAUSE OF SLOWER REFLEXES, THE BECAUSE OF SLOWER REFLEXES, THE ELDERLY OFTEN RECEIVE FACIAL INJURIES ELDERLY OFTEN RECEIVE FACIAL INJURIES DURING A FALLDURING A FALL

INJURIES INCURRED DURING A FALL CAN INJURIES INCURRED DURING A FALL CAN SEVERELY DECREASE PHYSICAL SEVERELY DECREASE PHYSICAL FUNCTIONING AND SUBSEQUENTLY FUNCTIONING AND SUBSEQUENTLY AFFECT THE QUALITY OF LIFE FOR THE AFFECT THE QUALITY OF LIFE FOR THE INDIVIDUALINDIVIDUAL

FALLS DEFINEDFALLS DEFINED

ACCORDING TO THE MERCK MANUEL OF ACCORDING TO THE MERCK MANUEL OF GERIATRICS AND THE DEPARTMENT OF GERIATRICS AND THE DEPARTMENT OF HEALTH: HEALTH:

A A FALL IS ANY DROP FROM A FALL IS ANY DROP FROM A HIGHER TO A LOWER POSITIONHIGHER TO A LOWER POSITION

COMPONANTS OF A RISK ASSESSMENTCOMPONANTS OF A RISK ASSESSMENT

REVIEW PAST FALLS REVIEW PAST FALLS REVIEW PREVIOUSLY MENTIONED RISK FACTORSREVIEW PREVIOUSLY MENTIONED RISK FACTORS

COMPLETE A HISTORY AND PHYSICAL COMPLETE A HISTORY AND PHYSICAL SCREEN ROUTINELY; I.E. WHEN MDS DUESCREEN ROUTINELY; I.E. WHEN MDS DUE TRACK AND REVIEW THE CIRCUMSTANCES TRACK AND REVIEW THE CIRCUMSTANCES

SURROUNDING EACH FALL SURROUNDING EACH FALL REVIEW MEDICATION CHANGES REVIEW MEDICATION CHANGES REVIEW NEED FOR ALARMS OR OTHER DEVICESREVIEW NEED FOR ALARMS OR OTHER DEVICES DISCOURAGE THE USE OF RESTRAINTSDISCOURAGE THE USE OF RESTRAINTS

POST FALL ASSESSMENTPOST FALL ASSESSMENT

VITAL SIGNS AND IMMEDIATE PHYSICAL VITAL SIGNS AND IMMEDIATE PHYSICAL ASSESSMENT BY RN (INCLUDE OTHOSTATIC BPS, ASSESSMENT BY RN (INCLUDE OTHOSTATIC BPS, TEMP)TEMP)

DETAILS FROM ANY WITNESSESDETAILS FROM ANY WITNESSES DETAILS FROM RESIDENT DETAILS FROM RESIDENT ENVIRONMENTAL FACTORS (LIGHTING, ENVIRONMENTAL FACTORS (LIGHTING,

OBSTRUCTIONS TO MOVEMENT) OBSTRUCTIONS TO MOVEMENT) CHANGES IN FUNCTIONAL STATUS CHANGES IN FUNCTIONAL STATUS MEDICATION CHANGES MEDICATION CHANGES INTENT THAT CAUSED FALL (GOING TO INTENT THAT CAUSED FALL (GOING TO

BATHROOM, REACHING FOR ITEM ON FLOOR)BATHROOM, REACHING FOR ITEM ON FLOOR)

ONGOING ASSESSMENTSONGOING ASSESSMENTS

TRACK RECURRENT FALLS TRACK RECURRENT FALLS DETERMINE SHIFT OR TIME OF DAY DETERMINE SHIFT OR TIME OF DAY

TRENDS TRENDS DETERMINE TRENDS R/T CAREGIVER DETERMINE TRENDS R/T CAREGIVER REVIEW MEDICATION ADMINISTRATION REVIEW MEDICATION ADMINISTRATION

TIMES R/T FALLS TIMES R/T FALLS DETERMINE RELATIONSHIP TO ILLNESS OR DETERMINE RELATIONSHIP TO ILLNESS OR

SIGNIFICANT CHANGESIGNIFICANT CHANGE

ADDITIONAL POST FALL INFORMATIONADDITIONAL POST FALL INFORMATION

RESIDENT DID NOT USE ASSISTIVE DEVICE RESIDENT DID NOT USE ASSISTIVE DEVICE RESIDENT LOST BALANCE RESIDENT LOST BALANCE RESIDENT LOST CONSCIOUSNESS RESIDENT LOST CONSCIOUSNESS RESIDENT WAS DIZZY BEFORE OR DURING FALLRESIDENT WAS DIZZY BEFORE OR DURING FALL RESIDENT HAD DIFFICULTY SEEING WHERE HE/SHE WAS RESIDENT HAD DIFFICULTY SEEING WHERE HE/SHE WAS

GOING GOING RESIDENT WAS CONFUSED AT TIME OF THE FALLRESIDENT WAS CONFUSED AT TIME OF THE FALL RESIDENT WAS NEW TO THE ENVIRONMENT (NEW RESIDENT WAS NEW TO THE ENVIRONMENT (NEW

RESIDENT OR ROOM CHANGE) RESIDENT OR ROOM CHANGE) RESIDENT HAD BEEN GIVEN A LAXITIVE OR DIURETIC PRIOR RESIDENT HAD BEEN GIVEN A LAXITIVE OR DIURETIC PRIOR

TO THE FALL TO THE FALL RESIDENT DID NOT HAVE CALL BELL IN REACHRESIDENT DID NOT HAVE CALL BELL IN REACH

OTHER CONTRIBUTORY OTHER CONTRIBUTORY CONSIDERATIONS R/T FALLSCONSIDERATIONS R/T FALLS

DIABETES:DIABETES:1.PERIPHERAL NEUROPATHY-CAN’T FEEL1.PERIPHERAL NEUROPATHY-CAN’T FEEL FOOT FOOT PLACEMENT, PAINFUL FEET, PLACEMENT, PAINFUL FEET, DEFORMITIES DEFORMITIES MAKING WALKINGMAKING WALKING DIFFICULT, DIFFICULT, DIABETIC FOOT ULCERSDIABETIC FOOT ULCERS 2. 2. RETINOPATHY-VISUAL DECLINERETINOPATHY-VISUAL DECLINE 3. 3. AUTONOMIC NEUROPATHY-AUTONOMIC NEUROPATHY- ORTHOSTATIC ORTHOSTATIC HYPOTENSIONHYPOTENSION 4. HYPOGLYCEMIC 4. HYPOGLYCEMIC EVENT-LOSS OF EVENT-LOSS OF CONSCIOSNESSCONSCIOSNESS

5. HYPERGLYCEMIC POLYURIA-5. HYPERGLYCEMIC POLYURIA-NEED TONEED TO URINATE QUICKLYURINATE QUICKLY

OTHER CONTRIBUTORY OTHER CONTRIBUTORY CONSIDERATIONS R/T FALLSCONSIDERATIONS R/T FALLS

EFFECTS OF MEDICATIONSEFFECTS OF MEDICATIONS1. DECLINE IN ELDERLY-GI, HEPATIC 1. DECLINE IN ELDERLY-GI, HEPATIC & RENAL FAILURE& RENAL FAILURE2. FRAIL ELDERLY OFTEN HAVE 2. FRAIL ELDERLY OFTEN HAVE

MULTI-MULTI- SYSTEM DECLINESYSTEM DECLINE3. POLYPHARMACY IN ELDERLY3. POLYPHARMACY IN ELDERLY4. DRUG ACCUMULATION4. DRUG ACCUMULATION

5. DRUG INDUCED DELERIUM AS 5. DRUG INDUCED DELERIUM AS OPPOSED TO DEMENTIAOPPOSED TO DEMENTIA

SIDE EFFECTS OF DRUGS R/T FALLSSIDE EFFECTS OF DRUGS R/T FALLS

BENZODIAZEPINES (ATIVAN, XANAX), BENZODIAZEPINES (ATIVAN, XANAX), NARCOTICS, NEUROLEPTICS, ANY DRUG NARCOTICS, NEUROLEPTICS, ANY DRUG WITH ANTICHOLINERGIC EFFECTS WITH ANTICHOLINERGIC EFFECTS (TRYCYCLIC ANTIDEPRESSENTS & SIME (TRYCYCLIC ANTIDEPRESSENTS & SIME INCONTINENCE DRUGS-OXYBUTININE)INCONTINENCE DRUGS-OXYBUTININE)

CAN CAN CAUSE COGNITIVE IMPAIRMENT & CAUSE COGNITIVE IMPAIRMENT & CONFUSIONCONFUSION


ANTICONVULSANTS, ANTIDEPRESSENTS, ANTICONVULSANTS, ANTIDEPRESSENTS, BENZODIAZAPINES, NARCOTICS, BENZODIAZAPINES, NARCOTICS, NEUROLEPTICS(ANTIPSYCHOTICS); CAN CAUSE DIZZINESS, NEUROLEPTICS(ANTIPSYCHOTICS); CAN CAUSE DIZZINESS, ORTHOSTATIC HYPOTENSION, SEDATION, DROWSINESSORTHOSTATIC HYPOTENSION, SEDATION, DROWSINESS

BETA BLOCKKERS, BETA BLOCKKERS,

NITRATES, VASODILATORS; CAN CAUSE SYNCOPENITRATES, VASODILATORS; CAN CAUSE SYNCOPE

ANTICONVULSANTS, BENZODIAZEPINES, ANTICONVULSANTS, BENZODIAZEPINES, NEUROLEPTICS; CAN CAUSE BALANCE PROBLEMSNEUROLEPTICS; CAN CAUSE BALANCE PROBLEMS


ANTIDEPRESSENTS,METOCLOPRAMIDE (REGLAN), ANTIDEPRESSENTS,METOCLOPRAMIDE (REGLAN), NEUROLEPTICSNEUROLEPTICS ; CAN CAUSE ABNORMALITIES ; CAN CAUSE ABNORMALITIES OF GAITOF GAIT

ANTIHYPERTENSIVES ANTIHYPERTENSIVES ; CAN CAUSE ; CAN CAUSE ORTHOSTATIC HYPOTENSIONORTHOSTATIC HYPOTENSION

ANTIARRHYTHMICS; ANTIARRHYTHMICS; CAN CAUSE ARRYTHMIASCAN CAUSE ARRYTHMIAS

DIURETICS; CAN INCREASE DIURETICS; CAN INCREASE URGENCYURGENCY


NEUROLEPTICS & ANY DRUG WITH NEUROLEPTICS & ANY DRUG WITH ANTICHOLINERGIC EFFECTS ANTICHOLINERGIC EFFECTS

CAN CAUSE VISUAL DISTURBANCES CAN CAUSE VISUAL DISTURBANCES

ANTIDEPRESSENTS,(SSRI, ANTIDEPRESSENTS,(SSRI, TRICYCLICS) NEUROLEPTICS, TRICYCLICS) NEUROLEPTICS, STIMULANTS, CAFFIENESTIMULANTS, CAFFIENE

CAN INCREASE AGITATIONCAN INCREASE AGITATION

PROCESSES FOR PREVENTIONPROCESSES FOR PREVENTION

EXERCISE TRAININGEXERCISE TRAINING1.IMPROVES STRENGTH AND BALANCE1.IMPROVES STRENGTH AND BALANCE2.WEIGHT BEARING TO DECREASE 2.WEIGHT BEARING TO DECREASE RISKRISK FOR FRACTUREFOR FRACTURE 3.DO AS AN 3.DO AS AN ACTIVITY TO INCREASE ACTIVITY TO INCREASE PSYCHOLOGICAL PSYCHOLOGICAL WELL BEINGWELL BEING 4. TEACH 4. TEACH MOVEMENT IN STEPS AND MOVEMENT IN STEPS AND GOOD GOOD SAFETY AWARENESSSAFETY AWARENESS 5. 5. CONTINUE WITH EFFECTIVE CONTINUE WITH EFFECTIVE RESTORATIVE & MAINTENANCE RESTORATIVE & MAINTENANCE PROGRAMINGPROGRAMING


MEDICATION INTERVENTIONMEDICATION INTERVENTION1. CALCIUM, VITAMIN D, FOSOMAX, 1. CALCIUM, VITAMIN D, FOSOMAX,

HORMONE REPLACEMENT IN TREATMENT HORMONE REPLACEMENT IN TREATMENT OF OSTEOPOROSISOF OSTEOPOROSIS 2. 2. MANAGING GLYCEMIC MEDICATIONS AND MANAGING GLYCEMIC MEDICATIONS AND DIET FOR DIABETICSDIET FOR DIABETICS 3. MANAGING 3. MANAGING PSYCHOTROPHIC MEDICATIONS AND SIDE PSYCHOTROPHIC MEDICATIONS AND SIDE EFFECTSEFFECTS 4. CARDIOVASCULAR 4. CARDIOVASCULAR MEDICATIONS AND/OR PACEMAKERMEDICATIONS AND/OR PACEMAKER


MEDICATIONSMEDICATIONSPERIODIC PHYSICIAN REVIEW PERIODIC PHYSICIAN REVIEW

FOR:FOR:POLYPHARMACYPOLYPHARMACYSIDE EFFECTSSIDE EFFECTSADMINISTRATION TIME AND ADMINISTRATION TIME AND WAKEFULNESS/URINATIONWAKEFULNESS/URINATIONALLERGIESALLERGIESDELERIUMDELERIUM


MANAGING DECLINING VISIONMANAGING DECLINING VISION1. ROUTINE VISION TESTING1. ROUTINE VISION TESTING2. USING CONTRASTING COLORS2. USING CONTRASTING COLORSIN HANDRAILS, WALKWAYS ETC.IN HANDRAILS, WALKWAYS ETC.3. EFFECTIVE LIGHTING IN 3. EFFECTIVE LIGHTING IN RESIDENT ROOMSRESIDENT ROOMS4. KEEPING GLASSES CLEAN AND 4. KEEPING GLASSES CLEAN AND ACCESSABLEACCESSABLE


CONSIDER CONDITION CHANGES:CONSIDER CONDITION CHANGES:1. MONITER LABS-CBC, GLUCOSE, HGB A1C,1. MONITER LABS-CBC, GLUCOSE, HGB A1C,ELECTROLYTESELECTROLYTES2. CHANGES IN DISEASE STATUS & 2. CHANGES IN DISEASE STATUS &

MEDICATION CHANGES-WORSENING MEDICATION CHANGES-WORSENING GAIT IN PARKINSONS DISEASEGAIT IN PARKINSONS DISEASE 3. 3. WORSENING PAINFUL MOVEMENT IN WORSENING PAINFUL MOVEMENT IN ARTTHRITIC CONDITIONS OR ARTTHRITIC CONDITIONS OR OSTEOPOROSIS (PRONE TO PATHOLOGICALOSTEOPOROSIS (PRONE TO PATHOLOGICALFRACTURE THAT MAY CAUSE FALL)FRACTURE THAT MAY CAUSE FALL) 4. 4. NEW ONSET FEVER, INFECTIONNEW ONSET FEVER, INFECTION


CONSIDER CONDITION CHANGES:CONSIDER CONDITION CHANGES:5. ORTHOSTATIC BP DROP CAUSED BY NEW 5. ORTHOSTATIC BP DROP CAUSED BY NEW MEDICATION, CHANGE IN MEDICATION, CHANGE IN

CARDIOVASCULAR STATUSCARDIOVASCULAR STATUS 6. 6. MONITER O2 LEVELS FOR MONITER O2 LEVELS FOR CONFUSION, LOSS OF CONFUSION, LOSS OF CONSCIOUSNESS R/TCONSCIOUSNESS R/THYPOXIAHYPOXIA 7. 7. MONITER APICAL PULSE FOR MONITER APICAL PULSE FOR CHANGES IN CHANGES IN RATE/RHYTHM OF HEARTRATE/RHYTHM OF HEART 8. CONSIDER 8. CONSIDER A UTI IF MENTAL STATUSA UTI IF MENTAL STATUS CHANGE CHANGE AND/OR WEAKNESS (FALL MAY BEAND/OR WEAKNESS (FALL MAY BE ONLY SX OF ONLY SX OF UTI)UTI)


LOOK AT THE ENVIRONMENT:LOOK AT THE ENVIRONMENT:LIGHTINGLIGHTINGCLUTTERCLUTTERFLOORS & MATSFLOORS & MATSTHRESHHOLDS & UNEVEN THRESHHOLDS & UNEVEN

SURFACESSURFACESHEIGHT OF CHAIRS/TOILET SEATSHEIGHT OF CHAIRS/TOILET SEATSHEIGHT OF BEDHEIGHT OF BEDITEMS WITHIN REACHITEMS WITHIN REACHEXCESSIVE DISTRACTING NOISEEXCESSIVE DISTRACTING NOISE


ASSISTIVE DEVICES:ASSISTIVE DEVICES:WALKERS, CANES, WHEELCHAIRSWALKERS, CANES, WHEELCHAIRSMERRYWALKERSMERRYWALKERSHANDRAILSHANDRAILSSPECIALTY FOOTWEARSPECIALTY FOOTWEARHIP PROTECTORSHIP PROTECTORS

ALARMS? ASSISTIVE OR CAUSE ALARMS? ASSISTIVE OR CAUSE AGITATION?AGITATION?

RESTRAINTS DO NOT PREVENT FALLS RESTRAINTS DO NOT PREVENT FALLS INCLUDING SIDE RAILSINCLUDING SIDE RAILS

ONGOING SUPPORT AND FOLLOW ONGOING SUPPORT AND FOLLOW THROUGHTHROUGH

MUST HAVE AN EFFECTIVE PROCESS MUST HAVE AN EFFECTIVE PROCESS TO EVALUATE IMMEDIATELY, WHEN TO EVALUATE IMMEDIATELY, WHEN THE FALL OCCURS, THE FALL OCCURS, AND ONGOING, TO DETERMINE AND ONGOING, TO DETERMINE TRENDS FOR POSSIBLE RECURRENCETRENDS FOR POSSIBLE RECURRENCE

F/U ONGOINGF/U ONGOING KEEP TRACK OF REPORTS ON FALLS AND AUDIT KEEP TRACK OF REPORTS ON FALLS AND AUDIT

FOR IMMMEDIATE REPONSE FOR INTERVENTIONSFOR IMMMEDIATE REPONSE FOR INTERVENTIONS

WEEKLY MEETINGS TO WEEKLY MEETINGS TO INCLUDE NURSING STAFF INCLUDING AIDS, INCLUDE NURSING STAFF INCLUDING AIDS, THERAPY AND RESTORATIVE, RNAC OR MDS THERAPY AND RESTORATIVE, RNAC OR MDS COORDINATOR; MEDICAL DIRECTOR, RESIDENT COORDINATOR; MEDICAL DIRECTOR, RESIDENT AND/OR FAMILY MAY ALSO BE BENEFICIAL AND/OR FAMILY MAY ALSO BE BENEFICIAL

CONSIDER USE OF ALARMS, CONSIDER USE OF ALARMS, CORRECT PLACEMENT AND RESPONSE TO CORRECT PLACEMENT AND RESPONSE TO (INCLUDING HOW RESIDENT REACTS)(INCLUDING HOW RESIDENT REACTS)

INVESTIGATION AND TRENDINGINVESTIGATION AND TRENDING

BASIC INFORMATION FOR TRENDING:BASIC INFORMATION FOR TRENDING:TIME OF DAYTIME OF DAYDAY OF WEEK DAY OF WEEK HALL OR WINGHALL OR WINGCNA ASSIGNMENTCNA ASSIGNMENTPRESENCE OF TOILETING DEPENDENCE PRESENCE OF TOILETING DEPENDENCE AND PROGRAMS IN PLACEAND PROGRAMS IN PLACEFUNCTIONING AND USE/MISUSE OF FUNCTIONING AND USE/MISUSE OF ALARMSALARMS

USE/DAMAGE OF ASSISTIVE DEVICESUSE/DAMAGE OF ASSISTIVE DEVICES

FALLS ARE EVERYONE’S FALLS ARE EVERYONE’S RESPONSIBILITYRESPONSIBILITY

INVOLVE THE WHOLE TEAMINVOLVE THE WHOLE TEAM*INCLUDE THE RESIDENT*INCLUDE THE RESIDENT

*AVOID INJURY*AVOID INJURY*BE AWARE OF CHANGES *BE AWARE OF CHANGES

IN THE RESIDENT IN THE RESIDENT*BE AWARE OF *BE AWARE OF ENVIRONMENTAL ENVIRONMENTAL CHANGECHANGE

ASK FOR HELPASK FOR HELP

PARRIPARRIPENNSYLVANIA RESTRAINT PENNSYLVANIA RESTRAINT REDUCTION INITIATIVEREDUCTION INITIATIVE

DEVELOPED WITH CMS AND ISDEVELOPED WITH CMS AND IS A A PROGRAM O KENDAL PROGRAM O KENDAL OUTREACH, OUTREACH, LLCLLC

REFERENCESREFERENCES

1.1. RIEFKOHL, ELSARIS Z., PHARMD;ET AL. MEDICATIONS AND RIEFKOHL, ELSARIS Z., PHARMD;ET AL. MEDICATIONS AND FALLS IN THE ELDERLY: A REVIEW OF THE EVIDENCE AND FALLS IN THE ELDERLY: A REVIEW OF THE EVIDENCE AND PRACTICAL CONSIDERATIONS. P&T, NOVEMBER PRACTICAL CONSIDERATIONS. P&T, NOVEMBER 2003,VOL28.NO.11;724-7332003,VOL28.NO.11;724-733

2.2. TREMBLAY, K.R.JR., AND BARBER, C.E. PREVENTING FALLS IN TREMBLAY, K.R.JR., AND BARBER, C.E. PREVENTING FALLS IN THE ELDERLY, NO. 10.242, COLORADO STATE THE ELDERLY, NO. 10.242, COLORADO STATE UNIVERSITY;WWW.EXT.COLOSTATE.EDU/PUBS/CONSUMER/1024UNIVERSITY;WWW.EXT.COLOSTATE.EDU/PUBS/CONSUMER/10242.HML2.HML

3.3. AMERICAN GREIATRICS SOCIETY, BRITISH GERIATRICS SOCIETY, AMERICAN GREIATRICS SOCIETY, BRITISH GERIATRICS SOCIETY, AND AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS PANEL AND AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS PANEL ON FALLS PREVENTION. GUIDELINE FOR THE PREVENTION OF ON FALLS PREVENTION. GUIDELINE FOR THE PREVENTION OF FALLS IN OLDER PERSONS.JAGS 49:664-672, 2001 FALLS IN OLDER PERSONS.JAGS 49:664-672, 2001

4.4. CDC INJURY CENTER. FALLS IN NURSING HOMES FACT SHEET. CDC INJURY CENTER. FALLS IN NURSING HOMES FACT SHEET. 2/19/2009; WWW.CDC.GOV/NCIPC/FACTSHEETS/NURSING.HTM2/19/2009; WWW.CDC.GOV/NCIPC/FACTSHEETS/NURSING.HTM

REFERENCESREFERENCES

5. MAURER, MATHEW S., BURCHAM, JOYCE AND HUAI CHENG. 5. MAURER, MATHEW S., BURCHAM, JOYCE AND HUAI CHENG. DIABETES MELLITUS IS ASSOCIATED WITH AND INCREASED RISK DIABETES MELLITUS IS ASSOCIATED WITH AND INCREASED RISK OF FALLS IN ELDERLY RESIDENTS OF A LONG-TERM CARE OF FALLS IN ELDERLY RESIDENTS OF A LONG-TERM CARE FACILITY. THE JOURNALS OF GERONTOLOGY SERIES A: FACILITY. THE JOURNALS OF GERONTOLOGY SERIES A: BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 60:1157-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 60:1157-1162(2205) THE GERONTOLOGICAL SOCIETY OF AMERICA1162(2205) THE GERONTOLOGICAL SOCIETY OF AMERICA

6. FALLS, THE MERCK MANUEL OF GERIATRICS, CHAPTER 20, 6. FALLS, THE MERCK MANUEL OF GERIATRICS, CHAPTER 20, SECTION 2; SECTION 2; WWW.MERCK.COM/MKGR/MMG/SEC2/CH20/CH20A.JSP

7. RUDDOCK, BRENT. MEDICATIONS AND FALLS IN THE ELDERLY. 7. RUDDOCK, BRENT. MEDICATIONS AND FALLS IN THE ELDERLY. DRUG INFORMATION AND RESEARCH CENTER, CPJ/RPC, DRUG INFORMATION AND RESEARCH CENTER, CPJ/RPC, JULY/AUGUST 2004, VOL. 137, NO. 6 JULY/AUGUST 2004, VOL. 137, NO. 6

8. CRITERIA FOR URINARY TRACT INFECTION IN THE ELDERLY, 8. CRITERIA FOR URINARY TRACT INFECTION IN THE ELDERLY, ONLINE CME FROM MDESCAPE; ONLINE CME FROM MDESCAPE; WWW.MEDSCAPE.COM/VIEWARTICLE/481627_2

9. HTTP:PARRI.KENDALOUTREACH.ORG/CONTACT.ASPX9. HTTP:PARRI.KENDALOUTREACH.ORG/CONTACT.ASPX

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