Improving Quality and Safety in the Workplace Starting with Preventing Falls Jessica Fordham, MSN, APRN, FNP-C Mississippi University for Women Graduate DNP Student

 Nursing home residents account for about 20% of deaths from fall in the 65 and older age group  A 100 bed nursing home facility typically reports falls a year  Between half and three-quarters of nursing residents fall each year which is double compared to older adults living in the community Problem

 About 1800 people living in nursing homes die from fall each year  10%-20% nursing home falls cause serious injuries  Disability, functional decline and reduced quality of life can be the results of a fall  Countless falls and resulting serious injuries are preventable Problem

What is a Fall? “Fall” refers to unintentionally coming to rest on the ground, floor, or other lower level but not as a result of an overwhelming external force

 Fracture  Head Injury  Serious cut requiring suture  Bruising  Decline in function Complication of Fall

Why do Falls Occur?  Poor nutrition  Altered mental status  Poor vision  Medication side effects  Acute or chronic diseases  Altered walking and balance  Foot or shoe problems  Environmental hazard

 Substandard treatment  Inadequate resident monitoring  Failure or delay of necessary care Barriers to Fall Prevention

 Minimum Data Set (MDS) is a n interdisciplinary assessment tool required by federal regulation for use in nursing home facilities  Primary screening and assessment tool  Measure health status and serve as a comprehensive assessment for all residents  Measures physical, clinical, psycho-social functioning, and life care wishes Guidance

American Medical Directors Association (AMDA)  Assess patient history of fall  Is the patient at risk for falling  Medications  Underlying conditions  Functional status  Neurological status  Psychological factor  Environmental factors (bed rails up, hand rails, hip pads) Recommendations

 Determine fall factors in risk assessment  Quality assurance measures should be implemented  All residents should have an individualized care plan  Fall risk factors should be reviewed every 3 months Recommendation

STEADI (Stopping Elderly Accidents, & Injuries) Tool kit  Created for healthcare providers who treat older adults who are at risk for fall  Contains Fall precaution algorithm, basic information about falls, case studies, conversation starters, standardized gait and balance assessment instructional video, educational handouts about fall prevention Center for Disease Control

STEADI Algorithm

 Timed Up and Go Test  30- Second Chair Stand Test  4 Stage Balance Test Video eadi/videos.html Educational Videos

Timed Up and Go Test

 Muscle strengthening and exercise classes  Residential educational session concerning proper use of gait aids and environmental safety  Daily environmental safety inspection  PI Tracking to Ensure Adequate Patient Monitoring  Staff Continuing Educational Modules which includes medication management and environmental safety Other Ways to Prevent Fall

GOAL Promote the greatest level of independence ad mobility while simultaneously preventing falls and injuries.