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

Fall prevention zDefinition of a fall: zA 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) zAccording to the Institute for Healthcare Improvements, a fall also includes “patients assisted to the floor”.

Overview zDefinition of a fall zImportance of fall prevention (incidence and outcomes) zFall risk factors zOverview and goals of Falls Program zWhat is involved in the Falls Program zAssessment of falls zFalls interventions zProgram Outcomes

Incidence of falls zWhat? zWho? zWhen? zWhere? zWhy?

Outcomes of falls ypsychological effects (fear of falling) ydecreased level of functioning and independence yinjuries ymortality ydelayed discharges

Case Study

Risk factors: Environmental 3poor lighting 3floor surfaces 3unsteady furniture 3telephone, call bells not in easy reach 3height of seating 3cluttered pathways 3ill-fitting clothing, diapers 3non-working hearing aids 3dirty or improper eyeglasses 3inappropriate footwear

Risk factors: Physical 3age 3history of falls 3illness 3neurologic disease 3mobility or balance impairment 3postural hypotension 3sensory impairments 3incontinency 3poor nutrition

Risk Factors 3Cognitive 3Pharmacological (benzodiazepine/sedatives, polypharmacy >5 meds)

Overview of Falls Prevention Program 3Need for program 3Patient safety 3Multidisciplinary approach yProgram will only work if everyone helps out!

Goals of program 3Identification of patients at risk to fall 3Implementation of preventative measures to decrease falls 3Examination of circumstances surrounding a fall 3Educational program for staff 3Increase in patient and family participation and awareness of falls and fall prevention 3Monitoring of incidence, time and location of falls, severity of injury and overall effectiveness of the program

Procedure zFlow chart

Falls Screening zSPPICES

Assessment 3SPLATT (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]

What happens after a fall 3Incident Report

Interventions: Cognition 3Simplify tasks 3Avoid changes or make changes gradually 3Remove excessive stimulation 3Use clear, concise communication 3Provide consistency in staff and routine 3Provide orientation cues (calendars, clocks)

Interventions: Cognition 3Increase light at twilight 3Provide meaningful activity 3Follow “Least Restraints Guidelines” 3Encourage family members/friends/sitters to remain with patient

Interventions: Physical Status 3Place hearing/visual aids close by 3Encourage toiletting routine (q2hrs) 3Provide bedside commode 3Ensure urinal is within reach 3Reduce fluid intake after dinner 3Ensure patient maintains adequate nutrition 3Encourage patient to dangle before standing/walking 3Encourage patient to perform ankle pumping in sitting position before walking 3Encourage patient to sit down immediately if feeling dizzy

Interventions: Mobility/Gait 3Make sure patient uses proper gait aid 3Place gait aids at side of bed (canes at bottom of bed) 3Ensure gait aids are at appropriate height 3Provide visual cues/signs to remind patient of safety techniques for transfers, ambulation

Interventions: Mobility/Gait 3Ensure patients wear shoes/non-skid socks at all times 3Provide patient and/or family with Falls Prevention Pamphlet 3ROM exercises, prevention of deconditioning 3Review fall prevention techniques with patient and/or family

Interventions: Environmental 3Ensure height of bed/chair is at level where the patient’s feet touch the floor 3Keep bottom bedrails down 3Ensure easy access to call bell, radio/tv controls 3Ensure improved lighting, minimize glare 3Maintain straight paths to bathroom

Interventions: Environmental 3Use bedside commodes for patients who can transfer independently but are unsafe to ambulate independently to bathroom 3Ensure clean, dry floors  Place higher risk patients in room near nurse's station 3Place higher risk patients in bed by bathroom 3Ensure brakes on equipment are operational

Interventions: Environmental 3Encourage use of appropriate footwear and properly fitting clothing 3Place garbage under sink and no basins on bathroom floor 3Remove equipment not in use 3Place IV equipment at top of bed 3Ensure nightlights are operational and in use 3Push bed against wall; place mattress on floor, beside bed, if patient climbing out of bed

Interventions: Meds  Review medication list for drugs which may predispose patient to falls 3Decrease use of benzodiazepines 3Diuretics given in the morning

Community Resources 3Day Hospital 3Falls Programs 3CCAC 3Day Programs 3Emergency Response Systems 3MOW 3Assistive Devices Program 3Wheel Trans

Outcomes of Program 3Staff, patients, families educated on fall prevention 3Increased awareness of need for teamwork to keep patients safe 3Decrease number of falls and injuries secondary to falls