Interventions to reduce harm from falls in ARRC facilities CMDHB ARRC Falls and Pressure Injury Collaborative Interventions to reduce harm from falls in ARRC facilities

The Evidence The Australian Commission on Safety and Quality in Health Care, (2009) Prevention of falls and Harm from Falls in Older People; Best practice guidelines for residential care facilities http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-RACF.pdf

Key falls prevention strategies (Level 1) Multifactorial approach using standard falls prevention interventions as routine care for all residents (Level 11) In addition targeted individualised falls prevention plan based on the findings of the falls screen/ assessment (Level 1) Provide Vitamin D with Calcium supplementation (Level 11) Medications reviewed by pharmacist

Falls risk screening recommendations Falls screen risk all residents on admission as soon as practicable Repeat regularly (6mths) or when functional status changes Use separate screening tools for residents who can and cannot stand unaided

Falls risk screening recommendations The introduction of falls risk screens and assessments needs to be supported with education for staff Audit to ensure appropriate and consistent use

Falls risk screening recommendations Screens and assessments will only be useful when supported by appropriate interventions related to the risks identified Identifying the presence of cognitive impairment should form part of the falls risk assessment process.

Falls risk screening Using a formal screening tool has the benefit of forming part of routine clinical management, and will inform further assessment and care for all residents. If a resident is identified as being ‘at risk’ for any item on a multiple risk factor screen, interventions should be considered for that risk factor even if the person has a low falls risk score overall.

Falls Risk Assessment Conduct falls risk assessments for residents who exceed the threshold of a falls risk screening tool, who suffer a fall, or who move to or reside in a setting where most people are considered to have a high risk of falls (e.g. high-care facilities, dementia units). Interventions delivered as a result of the assessment provide benefit; therefore, it is essential that interventions systematically address the identified risk factors.

Management strategies for common falls risk factors Balance and gait exercises for mobility limitations Restraint as the last option Environmental considerations Assessment by OT Physio Arrange personal belongings to suit resident and are safe and easy to use Individual surveillance and observation Syncope Dizziness Vertigo Assess for underlying cause e.g. Postural hypotension Medications Reviews Psycho- active drugs minimised Polypharmacy Continence Assessment Management UTIs Feet and foot wear Vision eye exams 2 yearly Cataract surgery as soon as possible History of falls avoid bifocals

Minimising injuries from falls Hip protectors The Howick Baptist story Vitamin D Prescribing rates CMDHB And the RCT Osteoporosis management Prevention of frailty # Post falls management What can we do to prevent the next fall ? The template Data

Understand what is happening Data Review data Learn from data There will be a time lag between starting a falls prevention programme and improvement Monitored and reviewed regularly The Erin Park story

Leadership and teams Many falls can be prevented Address at point of care and MDT perspective Strategies that prevent falls have other benefits e.g. balance / mobility Engage older people Even if harm is minor, factors such as fear of falling can impact on quality of life Best programmes include all staff Resourced adequately