5200 Introduction to Graduate Nursing Chasing Zero Falls 5200 Introduction to Graduate Nursing September 19,2012 Staci marchand, bsn, rn

Question What characteristics and risk factors are associated with falls and what is best practice to identify adult patients at risk of falling while hospitalized? What Characteristics/risk factors associated with falls 2. What is Best Practice to identify patients

OBJECTIVES Define falls Discuss characteristics related to falls Describe types of falls Describe risk factors associated with falls Discuss 3 fall risk assessment tools Describe best practice for fall prevention

A fall is defined as: An event whereby an individual unintentionally comes to rest on the ground or another lower level, with or without loss of consciousness.

MONITORING EFFECTIVENESS OF FALL REDUCTION PROGRAM Pay for performance Centers for Medicare & Medicaid Services (CMS) stop payment for treatments associated with injuries from nosocomial falls. Best Practice is to focus on improvement of fall rate over time within your own facility rather than comparing to other similar organizations. MONITORING EFFECTIVENESS OF FALL REDUCTION PROGRAM Loss of revenue 2. sustain injury incur charges over $4200 3. Benchmark against self secondary 4.culture of safety different at different facilities-reporting differently

Characteristics related to falls RN Skill Mix For 10% increase in RN, the odds of falling decreased by 18.8% How falls risk varies according to ward (Nazarko, 2011) Break down further - Neuro and Rehab highest rate of falls: conditions affect the ability to transfer HOW DO YOU THINK RN SKILL MIX AFFECTS FALLS? - Critical Thinking skills, assess & applying intervention Critical Thinking Skills Appling Interventions

Types of falls Medications Elimination Balance/gait Previous falls Anticipated Unanticipated Medications Elimination Balance/gait Previous falls Impulsive Confusion Poor vision/hearing Code Heart Attack Seizure Fainting Low Blood Sugar Bradycardia Characteristics 1. Anticipated –Predictable Characteristics : Related to age, functional ability diseases or conditions 2. Unanticipated – Characteristics : created by conditions that cannot be predicted.

risk factors Relating to Falls Intrinsic Patient Related Extrinsic Environmental Related Age related physiologic changes Diseases Muscle Weakness Gait Disorders Mental Status Polypharmacy Room layout Location of room Equipment Clutter Lighting Wet floors Type of flooring Intrinsic =patient related Extrinsic=environmental related Intrinsic risk factors account for 75% of falls. Intrinsic risk factors relate to anticipated falls which are predictable and preventable.

Fall reduction program Identify patients at risk Identify risk factors Treat risk factors Fall reduction program 3 Components to reduce falls

Fall risk assessment tools Morse Fall Scale (MFS) History of falling Secondary diagnosis Ambulation aid IV therapy Gait Mental status St Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) History of falls Mental status Disorientation/agitation Visual impairment Toileting need Transfer/mobility Hendrich II Fall Risk Model (HFRM) Confusion/disorientation/ impulsivity symptomatic depression Altered elimination Dizziness Sex (male) Prescribed anti-epileptic or benzodiazepines Get up and go test Fall risk score can be used to predict whether a patient is at risk of falling All tested in Acute Care setting Morse-highest score 125. Categorized into low, medium, high. Do not have elimination as a risk factor 2. STRATIFY-highest score 5 3. Built on intrinsic Risk factors 75% of falls are intrinsic Hendrich-highest score 16. Score ≥5 is high risk Plus= evaluates meds and get up and go test. Doesn’t evaluate history of falls because predictable falls always has at least one underlying risk factor and if they no longer have the risk factor fall risk declines.

PREDICT FALLS, Complete by interviewing, observation, history. Focuses on 8 risk factrors. Max score 16. Best Practice complete on admission, every shift, change of condition and ONGOING and after a fall occurs 1. Foley not considered altered elimination 2. Male-takes risk & ignore instructions. 3. Antiepileptics/benzodiazepines= affect CNS can cause weakness/gait change Successfully built into EMR with targeted interventions targeted.

For a Fall prevention program to be successful employees must? COMMUNICATE clearly with one another

summary Risk from falling cannot be eliminated, however falls can be reduced by implementing an effective fall risk assessment tool. A culture of safety must be created in order to have positive outcomes and to improve quality of care. Decrease falls by implementing Fall risk assessment

references Gray-Miceli, D. (2007). Fall risk assessment for older adults: the Hendrich II Fall Risk Model. Try This: Best Practices In Nursing Care To Older Adults, (8). Kim, E., Mordiffi, S., Bee, W., Devi, K., & Evans, D. (2007). Evaluation of three fall-risk assessment tools in an acute care setting. Journal Of Advanced Nursing, 60(4), 427-435. Nazarko, L. (2008). Falls part 4: prevention, assessment and intervention. British Journal Of Healthcare Assistants, 2(11), 535-539. Nazarko, L. (2011). Falls: A momentary slip and a lifetime of consequences. British Journal Of Healthcare Assistants, 5(12), 604-607. Stern C, Jayasekara R. Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic review. International Journal Of Evidence-Based Healthcare [serial online]. December 2009;7(4):243-249. Swann, J. (2010). Simple ways to prevent falls. British Journal Of Healthcare Assistants, 4(4), 166-169. Tideiksaar, R. (2009). Chapter 8: falls. In B. Bonder, V. Dal Bello-Haas, M. Wagner (Eds.) , Functional Performance in Older Adults (3rd Edition) (pp. 193-214). Philadelphia, Pennsylvania: F.A. Davis Company. Titler, M. G., Shever, L. L., Kanak, M. F., Picone, D. M., & Qin, R. (2011). Factors associated with falls during hospitalization in an older adult population. Research & Theory For Nursing Practice, 25(2), 127-152.