Improving Patient Safety in Long-Term Care Facilities: Falls Prevention and Management

1. Improving Patient Safety in Long-Term Care Facilities:Falls Prevention and Management • Student Version

2. Introduction • Falls Prevention: The role of the team in preventing falls • Falls Management: The role of the team in responding to a fall

3. Definition of a Fall

4. Facts About Falls in LTC Facilities • Preventing falls is a serious challenge. • Three of every four residents fall each year. • Most facilities have >100 falls per year. • There are several interventions that help reduce the number of falls. • Staff must have adequate training to acquire the knowledge and skills necessary to prevent and manage falls.

5. Risk Factors And Prevention Strategies For Falls • Resident-centered • Environmental • Facility-based • Organizational

6. Patient-Centered Risk Factors • Previous falls • Fear of falling • Diminished strength • Gait/balance impairments • Vision impairment • Alzheimer’s disease/dementia • Medications

7. Focus on: Medications Drugs known to increase the risk of falls Any drug that causes the following increases the risk of falling. • Drowsiness • Dizziness • Hypotension • Parkinsonian effects • Ataxia/gait disturbance • Vision disturbance

8. Case #1: Mrs. Lawson

9. Case #1: Mrs. Lawson

10. Case #1: Mrs. Lawson

11. Case #1: Discussion • Questions: • Given Mrs. Lawson’s history, diagnoses and medications, what is her risk for experiencing a fall? • What steps can staff take to reduce the risk and incidence of falls for Mrs. Lawson? • Important to note: • The patient’s history of falls and the medications she receives puts her at increased risk for falling. • Review the patient’s current medications. • Assess BP frequently.

12. Medication Management and Reduction Programs • Unless prescribed, avoid administering meds at meal times. • Determine a time during the day to give once daily medications. • Reduce TID meds to BID whenever possible. • Adjust the timing of BID meds to times that work best for the individual resident’s schedule. • Discontinue unnecessary medications. • Reduce the number of PRN medications. • Discontinue waking residents for medication whenever possible.

13. Facility-Based Risk Factors • Overcrowded rooms • Obstacles • Design issues • Equipment misuse or malfunction

14. Organizational Risk Factors • Inadequate staffing • Poor communication • Inadequate staff training • Inadequate QI policy for falls prevention • Use of restraints

15. Falls Assessment Instruments Common Assessment Elements History of falls Cognition Impulsivity Vision Attached equipment Ambulation Continence High-risk medications Assistive devices Familiarity with environment • Hendrich II Fall Risk Model • Comprehensive Falls Risk Screening Instrument • Falls Assessment portion of The Falls Management Program • Vanderbilt Fall Prevention Program for Long-Term Care • Timed Up and Go Test

16. HEAR ME Hazards — notice and eliminate environmental hazards Education — educate residents about safety Anticipate — anticipate the needs of residents Round — round frequently to learn residents’ needs Materials — ensure materials and equipment are in working order Exercises — assist residents with exercise and ambulation

17. Case #2: Mr. Phillips

18. Case #2Mr. Phillips

19. Case #2Mr. Phillips

20. Case #2: Discussion • Questions: • What patient-related factors make Mr. Phillips prone to falling? • What environmental factors may have been at play? • Important to note • The HEAR ME acronym could be used to highlight necessary changes to the patient’s environment. • Assistive devices should be checked. • Eye glasses should be checked and kept close. • Nighttime staffing should be reviewed.

21. Falls Management • Responding to a fall • Limiting future falls

22. Responding to a Fall 1. Observe and evaluate 2. Investigate and document 3. Implement individualized care plan 4. Develop falls management program

23. Limiting Future Falls Patient Interventions Center-wide Interventions Medication management and reduction program Falls management team Falls surveillance Multidisciplinary assessments Assessment of staffing needs Falls prevention and management training for staff and residents • Keep frequently needed items close • Remove hazards • Add safety equipment • Provide additional aid • Provide a balance exercise program • Evaluate assistive devices • Develop a care plan

24. Falls Management Team • Interdisciplinary group • Meet regularly • Analyze risk factors for falls • Identify intervention(s) • Perform systemic evaluation • Monitor and document results

25. Role Of The Care Team In Falls Prevention and Management • Licensed nurses have assessment skills and knowledge about medications that are essential to preventing and managing falls. • NAs and other front-line staff spend more time with residents, which gives them insight on how to prevent falls in the context of residents daily activities.

26. Teamwork • Communication • Report possible risks across the care team • Work together to improve the risk(s) • Take action as a team

27. Case #3: Mrs. Pelham

28. Case #3Mrs. Pelham

29. Case #2Mrs. Pelham

30. Case #3: Findings and Management

31. Case #3: Discussion • Ask the following questions: • What role did the Nursing Assistant play in ‘solving’ this case? • How might a breakdown in team communication have changed the outcome?

32. Quality Improvement • Plan: Identify a problem and design a change to address it. • Do: Implement a small change. • Study: Measure and analyze the effects of the change. • Act: Take action based on the results of analysis, such as trying another change.

33. Case #4: Increased Incidence of Falls

34. Case #4: Increased Incidence of FallsThe Problem • Falls have increased by 21% in past year • Team assembled to investigate • NAs • Licensed staff • Social Worker • Occupational Therapist

35. Case #4: Increased Incidence of FallsWhat the Team Learned • The facts: • Falls typically occur Thursday-Saturday • Between 9 AM and 2 PM • More falls occur more in women than men • The cause: • Floors deep cleaned Thurs-Sat after breakfast • Hairdresser onsite Thurs-Sat, 9 AM to 2 PM • Hair salon in basement

36. Key Points • Multiple risk factors • Fall risk assessment • Risk assessment after a fall • Fall prevention requires active engagement • Teamwork necessary to prevent falls • Go beyond incident report to develop a revised care plan after fall