Interventions to Reduce Harm From Falls Elaine Marshall, Leslie Bailey and the Team at Erin Park Rest Home and Hospital

Our Falls Definition Any event that results in resident being on the floor whether it is witnessed or not.

Our Interventions are a Balance Between Managing Falls Risk and Promoting Quality of Life Nursing management (risk assessments, toileting, fluid monitoring, weight management, staff supervision in lounges with residents, sensor mats) Environment (no mats, good lighting, no clutter, furniture height, chair and bed coverings) Medication management (review on admission and at least 3 monthly, proactive antipsychotic review and management, vitamin D for all residents, monthly geriatrician review) Personal safety (hip protectors, landing mats, safety aids, safe transfers, modified Otago Falls Prevention programme) Staff training (moving and handling training with physiotherapist, Careerforce, falls education) Monitoring and evaluation (A/I reporting, organisational/inter-organisational benchmarking)

Nursing Management Weekly review of call bell response times - 14,000 logged calls in 7 days - 99.5% (13,927) calls attended within 5min Reduction of UTI’s (112 residents)

Nursing Management (cont) Reduction in Restraint - currently 1 bedrail restraint and 1 enabler bed rail.

The Data – Evaluation Number of Falls 195 total falls per 40709 occupied bed days (112 beds; 46 Rest home and 64 hospital with ensuite toilet or toilet/shower) Rest Home falls - 49 falls (no fractures) - 14% of residents had 51% of falls (2-5 falls each; all reassessed for hosp level care) Hospital falls - 146 falls (3 fractures; nose, wrist, knee) - 12% of residents had 39% of falls (2-15 falls each)

Rest Home vs Hospital Falls Analysis

Fall Location

Fall Type Slip fall – slide to the floor from a seated position e.g. chair, bed, toilet Fall – fall from a standing position

Fall Cause

Time of Falls

Summary 4.3 falls/1000 occupied bed days. 0.1 fall fractures/1000 occupied bed days (no NOF# for residents wearing hip protectors). Majority (>60%) of falls are slips. >50% of RH falls from a standing position are due to loss of balance. 30% of all falls are associated with toileting. High number of falls are time-linked to specific nursing duties. Most dangerous area is a resident’s bedroom – in part due to design features but largely due to the actions of residents (e.g. missing edge of chair/bed/toilet)

Future Intervention Focus Initiated Resident bedrooms – fit for purpose (chair heights, coverings, doors, toilet access). Toileting – staff to remain in the residents bedroom while resident in the toilet. Staff duties – change practices at handover. To be Initiated Staff duties - change practices at staff meal times. Resident mobilisation training (specialist help) and education (including brochure on admission). Review Otago falls prevention programme - what should we be doing differently to improve resident balance. And We won’t be working in isolation – we will steal with pride everyone’s successful techniques to reduce harm from falls.

Together we can make a difference. Acknowledgement Thank you to : CMDHB for fostering a culture of knowledge sharing in aged care. Dr Shankar Sankaran for the programmes and partnerships that he has developed and established. Dr Noeline Whitehead for taking aged care under her wing. Together we can make a difference.