nursing fall prevention interventions

• Ensuring the seat is deep enough to allow no more than two fingers of width between the back of the person’s knee and the front of the chair. To increase the likelihood that individuals will remain seated, they must be comfortable and engaged in life around them. 3. … Making the aforementioned changes and substituting a wheelchair back that conforms to the curve of the kyphotic deformity will enable the individual’s trunk to stabilize behind the hip joint, preventing a forward fall head first from the chair. In this article, we review how to assess falls risk and discuss some key risk factors for falls and potential interventions to mitigate these risks. endstream endobj 72 0 obj <> endobj 73 0 obj <>/MediaBox[0 0 612 792]/Parent 69 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/Tabs/S/Type/Page>> endobj 74 0 obj <>stream h�b```�PV]a��1�A�i��=��h��0��G�J�.��%�)ӊv��'x��4�*H��0�LvS�ɾ��v��9�s�ECkG�D�kG�F�RGC��$pY4^��K>H��>Fu!�� _߁Ɂ��572z�-n��C��&{��Q0@� #@M When they reexamined their basic assumptions, reviewed her medical history, and spoke with her family, they learned that Ruth had incurred multiple injuries to her right hip during her active career as a tennis player and that these injuries were treated with steroid injections. In addition, when a fall occurs, systemic improvement depends on conducting a thorough root cause analysis of the fall, which includes tracking trends (eg, when, where, and how the fall occurred), the number of falls per unit, and whether any staff members were present. {,?�ʬ̣ی�-�A��-� �_�泒9ã�?��b\�1#E4��A�H�e8�&Klj4��ʓ��crd� �cB�S��a1�%�;h��-�ϣ��A6-nEh��G�%�o��4g+��Fe~�;̫BɰE�P��^��%RZ�[?�h��T��EJ)m��1��8&P��4WR��[��` �i�l5I�zo�פ_�;�OX�@�v"�K�LUs��6`�zp�q��5�rQ� o��2��v��v>.f�躘�g�b�>,�rp�-�^�#N��B�(x}(V _-~��+7F��K�� f ��-0e��Z��#�np�(�� ~�3Z3vp�"�Y��'c**�E~Q�!EuzR!�CJ#�b]�C��8P*�Q�A�ރ~^ɑ�yA�a\-�W�=hotS{5o={X��2�[��4; In addition, good evidence suggests that the benefits of vitamin D on fall prevention are distinct from its positive effects on bone health.7 Subsequently, the new consensus statement from the AGS recommends that healthcare providers review older patients’ vitamin D intake from all sources, including diet, sunlight exposure, and supplements, and work to achieve a total vitamin D input of 4000 international units daily (IU/day).23 The statement indicates that this will enable 90% of patients to achieve recommended vitamin D levels and minimize their risks of falls and fall-related injuries. Standing and walking should be maintained to the tolerance of each resident. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. For instance, it can be challenging for staff to prevent a fall in residents with dementia who habitually reach for unseen objects on the floor in front of their wheelchair while seated. Socks with grip… 31. Everyone moves away from painful stimulus and toward comfort. Rader J, Frank B, Brady C. Rethinking the use of position change alarms. Chicago, IL: American Medical Association; 2011:1-14. Ruth was a tall, lanky woman who had been a professional tennis player in her younger years. Preventing falls in the nursing home. 34. Once a comprehensive fall risk assessment is completed, the team must plan care interventions to reverse or address each risk identified on the falls assessment instrument. Most of these individuals can be safely seated in a standard wheelchair in which the angle of the seat back and the seat is kept at 90 degrees and the seat itself is tilted so that gravity is pushing the sacrum to the rear of the seat. In addition, charting near a frequent faller’s room, increasing staff availability, and staffing extra hours to cover a change of shift and during high-risk times of the day, such as the hour just after meals and during “sundowning,” may reduce risk. Use of several items that are worn by residents should be carefully considered, as they may help prevent falls and/or reduce the severity of injuries should a fall occur. SUGGESTED RESIDENT INTERVENTIONS TO MANAGE FALLS FALL FROM BED Resident Able to Transfer Make sure bed is locked and in lowest position Provide a night light Clear path to the bathroom—no obstacles Call light within reach and secured Toilet schedule Footwear to prevent slipping (ex. Syncope Trust And Reflex anoxic Seizures. 1988;36(3):266-278. In LTC settings, consideration should be given as to when it is ethically appropriate to discontinue the use of blood thinners, including aspirin, for individuals with advanced dementia, poor balance, and lapses in safety judgment.29 For those high-risk ambulatory elders in whom anticoagulation and antiplatelet therapy is continued, the use of high-impact helmets may be helpful in reducing the risk of subdural hematomas sustained from falls.30 Adherence with this strategy, however, can be difficult. STARS Website. Fall Prevention; Dementia Management; Safety; Nursing Interventions and Rationales 1. Using gravity to enhance the safety of their seating eliminates this problem,21 and this can be achieved as follows: • Placing the seat low enough to enable the person’s feet to be flat on the floor. Fall prevention in nursing homes continues to be a major focus for quality improvement in patient safety. Fall prevention in nursing homes presents multiple challenges. Housebound status 4. These individuals may be unable to detect uneven walking surfaces due to the lack of pressure and position sensations in the foot and ankle, presenting a real danger, particularly when paired with diminished sight and depth perception. Paper presented at: Transforming Fall Management Practices 2010 Annual Conference; May 2010; Clearwater, FL. Although it has become routine in LTC facilities to include orthostatic hypotension assessments during the resident’s initial intake process and after each fall incident, they are often administered by nursing assistants, who may be unaware of the resident’s recent changes in medication or history of heart arrhythmias; however, even when the assessments are administered by licensed practical nurses or other members of the care team, results may not be accurate due to measurements being taken at incorrect time intervals. The team interpreted Ruth’s body language of sliding to the front of the chair as a dementia-related behavioral problem instead of a symptom of pain, and their initial interventions led her to experience even more pain. __________________________________________________________________________________________________________________________ BMJ. As these cases show, post-fall huddles with an honest discussion of the circumstances surrounding the fall with the entire interdisciplinary care team and even the resident’s family members is critical, as each of these individuals may have important information that may help shed light on the actual cause(s) behind the fall. People with peripheral neuropathies or peripheral arterial disease of the lower extremities are at high risk for falls and the development of diabetic or arterial ulcers. 35. Historically, vitamin D and calcium have been administered concomitantly as a means of improving bone health. 13. Accessed December 30, 2013. Although the AGS/BGS guidelines do not make recommendations for or against hip protectors, the Veterans Administration Safety Center has adopted their use as best practice in their centers. Despite these interventions, she continued her attempts to slide forward, causing her to slip off the wheelchair seat to the floor. A comprehensive discussion of how to apply the PDSA in fall prevention programs is beyond the scope of this article, but what follows is a review of several factors that can contribute to falls among LTC residents and ways that these risks can be mitigated. These screenings should be accompanied by a review of the resident’s footwear to identify any poor fitting, broken, and unsafe shoes, such as those with wedge heels and slick bottoms. It also includes a comprehensive physical examination that evaluates mobility, joint function, cognitive/neurologic function, muscle strength, visual acuity, cardiovascular status, and feet/footwear, as well as a functional assessment that considers a patient’s ability to perform activities of daily living and gauges his or her fear of falling (eg, via the Falls Efficacy Scale). Leistikow IP, Kalkman CJ, de Bruijn H. Why patient safety is such a tough nut to crack. pdf.org/en/fall09_fall_prevention. Quigley P, Neily J, Watson M, Wright M, Strobel K. Measuring fall program outcomes. Cur-rently, no tool exists to guide nurses and other healthcare team members in assessing risk for in - jury from unanticipated falls… Fall reduction in any organization requires an organized, consistent approach to facilitate change and achieve sustainable outcomes. One practice reported experiencing a reduction in wandering after they relocated to a space that was more home-like and followed some of the design guidelines outlined in Geriatric Care by Design: A Clinician’s Handbook to Meet the Needs of Older Adults Through Environmental and Practice Redesign.16,17 This included using light to medium floor colors with no or simple patterns and low color contrast to improve perception; offering a variety of seating areas with firm or 0 Although only approximately 5% of adults aged 65 years and older live in nursing homes, this population accounts for approximately 20% of fall-related deaths in this age group.1,2 Between 50% and 75% of nursing home residents fall annually, which is twice the rate of falls in community-dwelling older adults.3 In addition, elderly individuals fall at an average rate of 2.6 falls per person per year.2,4 Falls result in disability, functional decline, reduced quality of life, and even death. As these data show, fall prevention is essential; however, this endeavor is challenging, as there is a lack of compelling evidence that any one intervention will reliably decrease the incidence of falls. There are several reasons: 1. Montero-Odasso M, Duque G. Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone. Finally, while most nursing homes provide wheelchairs that are wide enough for morbidly obese residents, many do not recognize the need for chairs that are deep enough to accommodate tall individuals as they lean forward. 11. Patients with dementia and other cognitive impairments may be prone to wandering, which can also increase the risk of falls. Clustering care is a vital part of every shift, not only for the patient, but for you as the … Tilting the angle of the seat by changing the wheel positions, lowering the back of the seat, and raising the front will bring the person’s face into a more vertical alignment and will encourage socialization and eye contact, and enable safer swallowing (Figure 2).21. 5. Falls Prevention Strategies & Interventions Submitted by Kentucky Association of Health Care Facilities EQUIPMENT/ENVIRONMENT Rearrange room to make better pathways to meet residents needs (like … Accessed September 20, 2013. Vitamin D and calcium recommendations: making sense of the hype and the reality. The biomechanics of maintaining one’s balance when seated and propelling a wheelchair requires that the person’s center of gravity remains within the wheelbase of the chair as he or she leans forward. Staff members become accustomed to these residents being independently safe during position changes, but these individuals are at higher risk for falls during this time period. Walking eventually became more difficult for him, so staff members started transporting him to and from the dining room by wheelchair. As Ruth’s case demonstrates, however, they need to look deeper. J Am Geriatr Soc. The three falls categories are accidental falls, anticipated physiological falls, andunanticipated physiological falls. Oliver D. Falls risk assessment tools in hospitals: mermaid or manatee? Unfortunately, the caregivers’ initial solutions to her sliding had strapped her further into a position of pain, which she was unable to communicate verbally. In the section that follows, we review some common factors that contribute to falls in LTC facilities, along with interventions that can be used to reduce injuries. Strategies for Reducing Falls in Long-Term Care Using Visual and Environmental Factors to Address Visual and Cognitive Deficits. J Clin Nurs. Betty Willy, PT, MA, CWS; Christine M. Osterberg, RN, BSN, Affiliations: Pathway Health Services, White Bear Lake, MN. Fall prevention: out with the old shoes, old habits. URMC Today. Rubenstein LZ, Robbins AS, Schulman BL, Rosado J, Osterweil D, Josephson KR. Accessed September 20, 2013. Harold’s primary diagnosis was Parkinson’s disease, and he initially required assistance walking to and from the dining room for meals. Selection of residents for this intervention could be based on a history of unresolved fall risk, presence of moderate to severe osteoporosis, and level of compliance with regard to such devices. 14. 88 0 obj <>/Filter/FlateDecode/ID[<2471E8DA354AF94DB0BCD60BCC9D2E61>]/Index[71 50]/Info 70 0 R/Length 92/Prev 754977/Root 72 0 R/Size 121/Type/XRef/W[1 3 1]>>stream Eur J Pain. �ӓf�^�B�o��Uc��v�뀵�� k,��w{t2��+F��-v��Wx��^w0�͏�Њ�5� ٫�h��zt� E�_�F��}��[Cܺ-�|��u��m�D��: 5��oY�2~>8�5?Oپ��_�X�U�Vw��nR�Y:��b_o��6� O��2,k��ҧ��A�W��w�$�>�;�;� Interventions for preventing falls in older people in care facilities and hospitals. Quality Improvement Organizations, Stratis Health. 2003;42(6):769-772. Children fall as they grow, develop coordination and new skills.and are often unaware of their limitations. Mountain Pacific Quality Health 2010. Physiological fall: A fall attributable to … In a webinar for Stratis Health from April 2012, Sue Ann Guildermann presented the unpublished results of a grant in which 16 nursing homes participated in a noise-reduction program in an attempt to reduce falls.20 The results strongly indicated that noise in the environment was the primary contributor to falls. Educational and research focus on the creation of sustainable change in LTC facilities is needed to create safer environments for our elders. If these measures do not alleviate the pain, pharmacologic measures can be considered, starting with mild analgesics. Accessed September 20, 2013. Life observation tells us that we as humans have a physiologic need to move. Direct nursing interventions to - ward post-fall care and preventing injury in case of another fall. Why is this important? Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Because nursing home residents have little or no sun exposure, it can be assumed that their vitamin D levels are lower than that found in the general population, particularly because it is difficult to get enough of this nutrient through diet. Falls in nursing homes. In both of these cases, the cause of falling was initially misidentified due to poor root cause analysis. 10. 2013;21(8):36-37. 29. Institute for Healthcare Improvement. The Role of Patient Care Assistant in Fall Prevention • Utilize universal fall precautions for all patients • Communicate with nurse about each patient’s risk factors and the plan to prevent a fall • Assist/remind patients as needed regarding fall prevention interventions • Communicate interventions …