Falls Prevention Nonrn

Falls Prevention A guide for direct care providers

My 68 year old wife fell while in the hospital for some colon surgery. The day I was to take her home she fell and hit her head. She should have been seen by a doctor immediately, but was put back in bed with a knot on her head and an ice-pack. She was on Coumadin. Falls are a fact in health care… Actual case—not a KMC patient. Used with permission.

By the time the neurosurgeon got notice of her it was 12 hours from the time of the fall. Her hematoma was very large and thick, pushing over the brain. She sustained an acute subdural hematoma. She was in a coma and I was told by two neurologists she would likely not ever gain consciousness.... Falls are costly, emotionally and financially… Actual case—not a KMC patient. Used with permission.

This was thirteen months ago. Today, thirteen months later, she is responsive and aware- but is pretty much paralyzed and speechless. She will move some with her right hand. She will smile, shrug her shoulders, wrinkle her nose, squeeze my hand, move her feet, and others. She has a trach, PEG, and ostomy. She cannot talk well, but can say her name… She is still bedridden. We attend her everyday in the nursing home. Falls can be tragic in their consequences Actual case—not a KMC patient. Used with permission.

Even if you’re not a direct care provider you need to know… Is there anything you could have done to prevent falls? What if you were the first person to find a person who has fallen? This module outlines the steps you can take to prevent falls and minimize their negative outcomes

The factors contributing to patient falls can be classified as environmental factors or patient factors Environmental factors refer to the environment of care, such as lighting, placement of equipment and furniture, floor coverings, maintenance, and other related factors Our policy require environmental rounds at a minimum of every four hours to ensure patient safety.

The factors contributing to patient falls can be classified as environmental factors or patient factors Patient factors refer patient characteristics, demographics and medical history

Falls Prevention involves four elements Create a safe environment This involves addressing environmental factors that contribute to patient falls

Falls Prevention involves four elements Create a safe environment Assess a patient’s risk This involves evaluating a patient for the presence of risk factors

Falls Prevention involves four elements Create a safe environment Assess a patient’s risk Reduce falls risks Individualized interventions to address patient risk factors

Falls Prevention involves four elements Create a safe environment Assess a patient’s risk Reduce falls risks Evaluate Interventions How effective are falls reduction efforts and interventions following a fall?

Creating a safe environment is everyone’s responsibility

Be aware of environmental risk factors that contribute to falls

These include:

Inadequate lighting Furniture or equipment in disrepair Improper bed position/side rails Clutter Slippery floor due to spills or overly polished Unfamiliar setting

Create a safe environment

Ensuring a safe environment for patient care prevents falls. It protects patients, visitors and staff members.

Every person working in a health care environment can contribute to maintaining a safe environment

Create a safe environment

Steps you can take to maintain a safe environment

Replace burned out lights (call engineering if necessary)

Unfamiliar setting- If you see someone who appears lost, offer assistance Keep rooms, hallways, and work areas clear of clutter Wipe up spills; pick up litter Keep all furniture in good repair; remove from service if defects noted Keep cords from pathways

Assess a patient’s risk Be aware of how environmental and patient factors interact; for example: The largest proportion of falls occur at night, in the patient’s room, are related to going to the bathroom, occur in patients receiving medications effecting the central nervous system or blood pressure The majority of patient who fell did not use the call light prior to falling. While it is the responsibility of the direct care staff to assess patients, all staff members need to at least be aware of these factors…

Factors for Falls Demographic factors Older age (especially >=75 years) White race Living alone Historical factors Use of cane or walker Previous falls Acute illness Chronic conditions, especially neuromuscular disorders Medications, especially the use of four or more prescription drugs Physical deficits Cognitive impairment Reduced vision, including age-related changes Difficulty rising from a chair Foot problems Neurologic changes, including age-related Decreased hearing, including age-related changes Others Environmental hazards Risky behaviors

Reduce falls risks All patients identified as high risk will have a comprehensive risk reduction plan developed with the patient and family. “ Catch a Falling Star” signs are to be used to identify high risk patients. If you see this sign, recognize that the patient is a high risk for falling.

Ruby Slippers Non-slip red slipper socks are use only on patients who have been identified as an increased risk for falling. If you see an unaccompanied patient with Ruby Slippers he or she may be a falls risk. Question the patient and call nursing if needed. The red slipper socks are to be used in addition to any sign in and near the patient’s room.

Reduce falls risks Many interventions to reduce falls address the environment of care; for example…

Suitable, sturdy locked equipment, such as wheelchairs/beds

Occupied beds in low position with wheels locked

Rooms and hallways clear of obstacles, such as excessive equipment. Room furniture arranged to allow space when walking, and accessible grab bars/hand rails

Two (2) foot wide path for patient/wheelchair: door to bed. Bed to commode, bed to chair.

Commode seats/lifts properly installed and tight

Floor is clean, dry and clear of personal items, spills and clutter

And involve housekeeping, engineering and others.

Evaluate interventions Quickly call for a nurse who will assess and summon a physician if needed After a fall If you are the first person to find a person who has fallen , regardless of where it occurs in the hospital, reassure the person and ask them to remain where they are until a nurse arrives If there an environmental factors, such as spills or clutter, that contribute to the fall, attend to them promptly.

The consequence of falls can be tragic Preventing falls depends on every one who works in a health care setting to do his or her part

Falls Prevention involves four elements Create a safe environment Assess a patient’s risk Reduce the patient’s risk with Individualized interventions Evaluate interventions Plus a fifth element…

Your actions to: C reate a safe environment– All Staff A ssess a patient’s risk– Direct Care R educe risks– All Staff E valuate the effectiveness of interventions – Direct Care Make all the difference… You Whether you are a direct care or a support staff, you have a role

Falls Prevention Congratulations, you’ve completed the Module… Now what? Take the Falls Prevent post test (next page). Print the test, complete, and submit to education (interoffice mail or drop it by the education office) For any questions regarding this module or its contents contact Education Department X2720 If you would like to know more about preventing falls you may access the Fall policy on the KMC Intranet

Falls Prevention Post Test for support staff Knowledge Assessment- print, complete, and submit to Education Department via interoffice mail or drop in 1. The four elements of Falls Prevents are: ________________________________ ________________________________ ________________________________ ________________________________ 2. Only direct care staff have a role in falls prevention True False 3. If I observe “ruby Slippers” on an unaccompanied True False patient I can ignore it Printed name ________________________________Title_____________________ Dept. ____________________________________________ Date _____________ Signature ___________________________ (signature certifies that I have read and understand the material in this presentation) To print , find and click on this symbol above on left When a box like this opens, under Print Range select Current page Then click OK **Important

References American Geriatric Society, British Geriatric Society, and American Academy of Orthopaedic Panel on Falls Prevention (2001). Guideline for the Prevention of Falls in Older Persons. Journal of American Geriatric Society (49) 664-672 Evans, D., Hodgkinson, B., Lambert, L. and Wood, J. (2001) Falls Risks in the Hospital Setting: A systematic Review. International Journal of Nursing Practice (1) 38-45 Tinnetti, M. (2003) Preventing Falls in Elderly Persons. New England Journal of Medicine . 348 (1), 42-49