Falls Prevention

1. Falls Prevention Shawna Cassidy, Physiotherapist Shoshana Berliner, Occupational Therapist North York General Hospital March 2006

2. Fall prevention • Definition of a fall: • A fall is considered “an event that results in a person coming to rest inadvertently on the ground or floor or other lower level.” (Registered Nurses Association of Ontario, 2002) • According to the Institute for Healthcare Improvements, a fall also includes “patients assisted to the floor”.

3. Overview • Definition of a fall • Importance of fall prevention (incidence and outcomes) • Fall risk factors • Overview and goals of Falls Program • What is involved in the Falls Program • Assessment of falls • Falls interventions • Program Outcomes

4. Incidence of falls • What? • Who? • When? • Where? • Why?

5. Outcomes of falls • psychological effects (fear of falling) • decreased level of functioning and independence • injuries • mortality • delayed discharges

6. Case Study

7. poor lighting floor surfaces unsteady furniture telephone, call bells not in easy reach height of seating cluttered pathways ill-fitting clothing, diapers non-working hearing aids dirty or improper eyeglasses inappropriate footwear Risk factors: Environmental

9. Risk factors: Physical • age • history of falls • illness • neurologic disease • mobility or balance impairment • postural hypotension • sensory impairments • incontinency • poor nutrition

10. Risk Factors • Cognitive • Pharmacological (benzodiazepine/sedatives, polypharmacy >5 meds)

11. Overview of Falls Prevention Program • Need for program • Patient safety • Multidisciplinary approach • Program will only work if everyone helps out!

12. Goals of program • Identification of patients at risk to fall • Implementation of preventative measures to decrease falls • Examination of circumstances surrounding a fall • Educational program for staff • Increase in patient and family participation and awareness of falls and fall prevention • Monitoring of incidence, time and location of falls, severity of injury and overall effectiveness of the program

13. Procedure • Flow chart

14. Falls Screening • SPPICES

15. Assessment • SPLATT (Falls History) S - symptoms at time of fall(s) P - previous number of falls or near falls L - location of fall(s) A - activity at time of fall(s) T - time of fall(s) and time on ground T - trauma or injury with fall(s) [physical, emotional]

16. What happens after a fall • Incident Report

17. Simplify tasks Avoid changes or make changes gradually Remove excessive stimulation Use clear, concise communication Provide consistency in staff and routine Provide orientation cues (calendars, clocks) Interventions: Cognition

18. Interventions: Cognition • Increase light at twilight • Provide meaningful activity • Follow “Least Restraints Guidelines” • Encourage family members/friends/sitters to remain with patient

19. Interventions: Physical Status • Place hearing/visual aids close by • Encourage toiletting routine (q2hrs) • Provide bedside commode • Ensure urinal is within reach • Reduce fluid intake after dinner • Ensure patient maintains adequate nutrition • Encourage patient to dangle before standing/walking • Encourage patient to perform ankle pumping in sitting position before walking • Encourage patient to sit down immediately if feeling dizzy

20. Interventions: Mobility/Gait • Make sure patient uses proper gait aid • Place gait aids at side of bed (canes at bottom of bed) • Ensure gait aids are at appropriate height • Provide visual cues/signs to remind patient of safety techniques for transfers, ambulation

21. Interventions: Mobility/Gait • Ensure patients wear shoes/non-skid socks at all times • Provide patient and/or family with Falls Prevention Pamphlet • ROM exercises, prevention of deconditioning • Review fall prevention techniques with patient and/or family

22. Interventions: Environmental • Ensure height of bed/chair is at level where the patient’s feet touch the floor • Keep bottom bedrails down • Ensure easy access to call bell, radio/tv controls • Ensure improved lighting, minimize glare • Maintain straight paths to bathroom

23. Interventions: Environmental • Use bedside commodes for patients who can transfer independently but are unsafe to ambulate independently to bathroom • Ensure clean, dry floors • Place higher risk patients in room near nurse's station • Place higher risk patients in bed by bathroom • Ensure brakes on equipment are operational

24. Interventions: Environmental • Encourage use of appropriate footwear and properly fitting clothing • Place garbage under sink and no basins on bathroom floor • Remove equipment not in use • Place IV equipment at top of bed • Ensure nightlights are operational and in use • Push bed against wall; place mattress on floor, beside bed, if patient climbing out of bed

25. Interventions: Meds • Review medication list for drugs which may predispose patient to falls • Decrease use of benzodiazepines • Diuretics given in the morning

26. Community Resources • Day Hospital • Falls Programs • CCAC • Day Programs • Emergency Response Systems • MOW • Assistive Devices Program • Wheel Trans

27. Outcomes of Program • Staff, patients, families educated on fall prevention • Increased awareness of need for teamwork to keep patients safe • Decrease number of falls and injuries secondary to falls