Home Care Falls Prevention and Management Program September 2011

Overview  Definition of falls and injury  Falls Assessment  Strategies and interventions  Evaluating  Roles and Responsibilities

What is a Fall? Staff were asked in June of 2011 to define what a “fall” was. Here are some of their answers: “Uncontrolled, accidental movement to the ground” “No longer in an upright position and is prone on the floor or sitting on the floor” “Person makes contact with the ground” “Loss of balance, trip, stumble – may hit floor” “Cooler weather!” (my personal favorite)

Definition of a Fall A Fall is: “An event that results in a person coming to rest inadvertently on the ground or floor or other lower level, with or without injury.”

Definition of an Injury An Injury is: “Any “disruption” in body integrity that was not present before the fall. This would include a scrape, bruise, bump, laceration, fracture, abrasion, etc.”

Consequences of Falls Fractures of hip, femur, humerus, wrist and rib Soft tissue injuries Hematoma (subdural or other body area) Transient confusion Social/psychological consequences (ex. loss of courage, independence, confidence and family reaction) Hospitalization Death

Canadian Statistics Falls are the leading cause of overall injury cost in Canada They account for $6.2 billion or 31% of total costs of all injuries in a year. (Safer HealthCare Now!2011) Falls are primary cause of injury admissions to Canada’s acute care hospitals, accounting for 57% of all injury hospitalizations and more than 40% of all admissions to long term care.

Home Care Statistics From April 2011 to August 2011 there have been 10 recorded falls at Home Care These are clients who are over the age of 65 and are case managed These falls have been identified using the Confidential Occurrence Report

Strategies and Interventions Falls prevention is a Required Organizational Practice (ROP) of Accreditation Canada. All areas are required to implement a falls prevention strategy.

Strategies at Home Care We are:  Implementing a Home Care Falls Committee/Program  Implementing a pilot project to reduce falls in areas 45 and 82 which includes the completion of a Home Safety Checklist  Educating all Home Care/SWADD staff about Falls

Home Care Falls Committee Members: Connie Fiorante RN co-chair Lori Tulloch – Director Glenda Popowich – Manager Tamara McDermit – Manager Linda Picot – Health Info Analyst Brenda Federko – HHA Tricia Murray – Office Assistant Carol Hepting – OT Cara Christian HHA co-chair Lorna Kathol – Manager Debbie Poncsak – Manager Vicki Demerse – MDS Manager Coleen Lundeen – RN Linda Voss – LPN Palliative sub-committee: Bev Cross

Fall Risk Interventions Evaluate gait & balance Introduce exercise – reduces falls by 37% Medication Review – reduces falls by 21% Supplement Vit D – reduces falls by 43% (refer to article) Treat Vision impairment (i.e. cataracts) Manage Postural Hypotension Assess home for risk factors (Home Safety Checklist)* Gradual withdrawal of psychotropics – reduces falls by 66% (ex. hs sedation) Educate staff about falls* * these are the interventions we are trying at Home Care

Home Care’s Fall Interventions Assess home for risk factors using the Home Safety Checklist – Pilot Area 45 & 82 –Client must be a case managed client who triggered the falls cap on initial needs assessment (in areas 45 & 82) –Referral will be initiated for HHA or Therapies to complete the Home Safety Checklist –Falls diary used to record falls for the year –Annual needs assessment done Educate all Home Care/SWADD staff about Falls

Home Safety Checklist Takes approx 10 mins to complete Many questions about home environment Asterisked questions answered with a “yes” will require referral to OT/PT Qualitative question at the back “Is there anything else you would like to say about falling or about your environment?”

Evaluating Baseline data collected in area 45 and 82 Falls diary will be collected every month and analyzed Comparison will be made between initial needs assessment and annual follow-up needs assessment

Roles and Responsibilities Support a safe environment Educate clients and family CEAC handout available “What to do if you have a fall”

Questions???