Download Nursing Home Restraints Collaborative

Falls Management
Tiresa Parker
Learning Session 1
October 2008
Risk of Falls
• 1 in 3 persons in the community fall every year
• About ½ of residents in nursing homes fall
every year
– 30-40% of them will fall again
– 1 in 10 residents who fall will have a serious injury
(about 11%)
Risk of Falls
• Most falls happen to women in their
homes in the afternoon
• Physical restraints INCREASE the
likelihood of a serious injury resulting
from a fall
Risk of Falls and Hip Fractures
Increases with Age
• 87% of fractures in those 65 yrs. and
older are caused by falls
• People 85 yrs. and older are 10-15 times
more likely to sustain hip fracture than
60-65 yr. olds
• Tall people appear to have an increased
risk of hip fracture when they fall
Long Term Care Population
• Older- average age at admission is 82.6 yrs
• More chronic disease- Over 50% of residents
have 3 or more admitting diagnoses
• More frail
– 48% receive full time skilled nursing care
under physician’s orders
– 98% require help with bathing
– 45% require help with eating
Consequences of Falls
•
•
•
•
Loss of function and independence
Increased fear of falling
Increased paperwork for staff
Higher acuity level and increased care
Consequences of Falls
• Poor relations with families and community
• Poor survey results
• Monetary awards from lawsuits and
increased insurance premiums
• Increased costs for care and staffing
Fall Risk Factors Effects of Aging
• Visual
– Decreased acuity, contrast sensitivity
– Decreased peripheral and night vision
– Increased sensitivity to glare
• Gait
– Reduced arm swing
– Decreased step length and step height
– Slowed reaction time
– Slower movement
Fall Risk Factors Effects of Aging
• Urinary Changes
– Feelings of urgency
– Frequency
• Chronic Diseases
– Diabetes, stroke, hyper/hypotension
– Arthritis, osteoarthritis, foot problems
– Parkinson’s, Alzheimer’s, other dementias
– Depression
• Acute Diseases
– Elder response
Fall Risk Factors Effects of Aging
• Poor Safety Practices
– Management of environment & equipment
– Toileting, bathing
– Transfer and ambulation
– Behavior management
• Environment
– Clutter, lighting, flooring, handrails
– Bed wheels, side rails, and beds
– Hard to reach items
Fall Risk Factors
Medications
• Antidepressants
• Antihypertensives
• Antipsychotics
• Benzodiazepines
• Diuretics
• Digoxin
• Narcotics
• Sedative/hypnotics
Fall Risk Factors
Medications
• Residents taking antipsychotics
(Risperadol), antidepressants (Zoloft or
Elavil) or benzodiazepines (Ativan) are
2-3 times more likely to fall
because of side effects:
– Drowsiness, over sedation
– Agitation, confusion, pacing
– Unsteadiness
– Gait disturbance
– Dizziness, orthostatic hypotension
Fall Risk Factors
Medications
• The more medications a resident takes,
the higher the fall risk
• Residents on 5-9 medications are
4 times more likely to fall
• Taking over 10 medications was
associated with a 6-fold increase in falls
Fall Risk Factors
Equipment
Wheelchairs
• Poor maintenance and need for repair
• Incorrect fit
• Wheelchair seating problems
• Missing or lost parts
In Summary
• Falls are a big concern for residents,
families, staff, facility administration,
regional and corporate offices, state
surveyors and the federal
government……
• By the year 2040 the annual rate of hip
fracture in the US will be > 500,000
with an annual cost of $240 billion
Business Case for Falls Prevention
• Preventing one fall, you save staff time
• Preventing one fall with injury,
you save even more staff time
• Preventing one lawsuit related to a fall,
you save thousands of dollars in
lawyer/settlement cost
It is Impossible to Prevent All Falls!
It is possible to use an
interdisciplinary team to:
• Reduce the frequency
• Utilize a multifaceted approach
• Implement individualized
interventions
• Document your actions carefully to
reduce the likelihood of litigation
Changing your Organizational Culture
• Create a blame-free environment for
reporting errors/injuries…
….changing your culture
• Improve your incident reporting systems
Changing Your Culture
• Leadership
• Falls are fully reported, investigated
and documented
• All staff, all shifts, all days are trained
• All staff problem solve
• All staff are held accountable
without blame or shame
Blame-Free Environment
• Create an atmosphere for reporting errors
without punishment
• Make it easy for staff to admit mistakes
• Focus on the system, not the individual
Strategies to Reduce Fall Risk
• Complete falls assessment upon admission,
annually, and on change in condition
(i.e. Morse Scale)
• Individualized care plan that is evaluated
and modified after each assessment or fall
• Evaluate medical status
• Evaluate medications
Strategies to Reduce Fall Risk
•
•
•
•
•
•
OT/PT evaluation
Gait and balance training
Evaluate behaviors
Increased activity and exercise programs
Evaluate equipment/posturing devices
Assess toileting schedule
Strategies to Reduce Fall Risk
•
•
•
•
•
•
Utilize low beds and mats
Individualized wheelchair seating
Alarms and sensors
Reduce to ¼ or ½ side rails
Utilize concave mattresses
Hip protectors
Strategies to Reduce Fall Risk
• Provide safe footwear
• Promote safe transfers
• Remove clutter
Falls Investigation
• Assessment and immediate
intervention at the time of the fall to
determine the cause and prevent
future falls
• Current care plan reviewed and
modified within 72 hours of the fall
Falls Investigation
Use a Comprehensive Report Form
•
•
•
•
•
•
Assessment and evaluation
Circumstances of fall
Causes
Staff response
Persons notified
Injuries
8 Step Fall Response
• Evaluate and monitor 24-72 hrs.
• Investigate fall
• Record circumstances, outcomes, and staff
response
• Communicate to PCP
• Immediate intervention
• Complete falls assessment
• Develop plan of care
• Monitor interventions and patient response
Collect and Analyze Falls Data
• Fall definition is clear to all
• Comprehensive investigative and
documentation tool
• Easy data entry and analysis
• Trending and feedback to staff
Analyze Falls Monthly
•
•
•
•
•
•
# of falls
# of fallers
# of serious injuries
# of recurrent fallers (2 or more)
Look by unit, shift, day, location
Trend your data over time
Behavior Management
• 50-80% of residents have some form of
cognitive loss (due to dementia)
• ½ of these residents have
behavioral symptoms
• Residents with dementia have a higher risk
of falling, are more likely to have an injury
• Utilize a behavior log to target
behaviors clearly
Activities
• Increase the number and levels of
activities and exercise programs
• Utilize activities staff
• Use volunteers, families, students
and friends to supervise residents
• Use activity boxes on units
• Reminiscence box
Promote Positive Behavior
• Keep something interesting in your pocket to
distract or stimulate resident’s interest
• Talk about things that interest resident
• Sing or say some lines of a song,
hymn or poem
• Demonstrate safe exercise
• Use a memory book
Emory Falls Program
is available along with other
restraint tools on
www.medqic.org
-click nursing home (top)
-click physical restraint (left)
-click tools (right)
-click falls management program
-click print