1. 5200 Introduction to Graduate Nursing
Chasing Zero Falls
5200 Introduction to Graduate Nursing
September 19,2012
Staci marchand, bsn, rn

2. Question
What characteristics and risk factors are associated with falls and what is best practice to identify adult patients at risk of falling while hospitalized?
What Characteristics/risk factors associated with falls
2. What is Best Practice to identify patients

3. OBJECTIVES
Define falls
Discuss characteristics related to falls
Describe types of falls
Describe risk factors associated with falls
Discuss 3 fall risk assessment tools
Describe best practice for fall prevention

4. A fall is defined as:
An event whereby an individual unintentionally comes to rest on the ground or another lower level, with or without loss of consciousness.

5. MONITORING EFFECTIVENESS OF FALL REDUCTION PROGRAM
Pay for performance
Centers for Medicare & Medicaid Services (CMS) stop payment for treatments associated with injuries from nosocomial falls. Best Practice is to focus on improvement of fall rate over time within your own facility rather than comparing to other similar organizations.
MONITORING EFFECTIVENESS OF FALL REDUCTION PROGRAM
Loss of revenue
2. sustain injury incur charges over $4200
3. Benchmark against self secondary
4.culture of safety different at different facilities-reporting differently

6. Characteristics related to falls
RN Skill Mix For 10% increase in RN, the odds of falling decreased by 18.8%
How falls risk varies according to ward (Nazarko, 2011)
Break down further - Neuro and Rehab highest rate of falls: conditions affect the ability to transfer
HOW DO YOU THINK RN SKILL MIX AFFECTS FALLS?
- Critical Thinking skills, assess & applying intervention
Critical Thinking Skills
Appling Interventions

7. Types of falls Medications Elimination Balance/gait Previous falls
Anticipated
Unanticipated
Medications
Elimination
Balance/gait
Previous falls
Impulsive
Confusion
Poor vision/hearing
Code
Heart Attack
Seizure
Fainting
Low Blood Sugar
Bradycardia
Characteristics
1. Anticipated –Predictable Characteristics : Related to age, functional ability diseases or conditions
2. Unanticipated – Characteristics : created by conditions that cannot be predicted.

8. risk factors Relating to Falls
Intrinsic
Patient Related
Extrinsic
Environmental Related
Age related physiologic changes
Diseases
Muscle Weakness
Gait Disorders
Mental Status
Polypharmacy
Room layout
Location of room
Equipment
Clutter
Lighting
Wet floors
Type of flooring
Intrinsic =patient related
Extrinsic=environmental related
Intrinsic risk factors account for 75% of falls.
Intrinsic risk factors relate to anticipated falls which are predictable and preventable.

9. Fall reduction program
Identify patients at risk
Identify risk factors
Treat risk factors
Fall reduction program
3 Components to reduce falls

10. Fall risk assessment tools
Morse Fall Scale (MFS)
History of falling
Secondary diagnosis
Ambulation aid
IV therapy
Gait
Mental status
St Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY)
History of falls
Mental status Disorientation/agitation
Visual impairment
Toileting need
Transfer/mobility
Hendrich II Fall Risk Model (HFRM)
Confusion/disorientation/ impulsivity
symptomatic depression
Altered elimination
Dizziness
Sex (male)
Prescribed anti-epileptic or benzodiazepines
Get up and go test
Fall risk score can be used to predict whether a patient is at risk of falling
All tested in Acute Care setting
Morse-highest score Categorized into low, medium, high. Do not have elimination as a risk factor
2. STRATIFY-highest score 5
3. Built on intrinsic Risk factors 75% of falls are intrinsic
Hendrich-highest score Score ≥5 is high risk
Plus= evaluates meds and get up and go test.
Doesn’t evaluate history of falls because predictable falls always has at least one underlying risk factor and if they no longer have the risk factor fall risk declines.

11. PREDICT FALLS, Complete by interviewing, observation, history.
Focuses on 8 risk factrors. Max score 16.
Best Practice complete on admission, every shift, change of condition and ONGOING and after a fall occurs
1. Foley not considered altered elimination
2. Male-takes risk & ignore instructions.
3. Antiepileptics/benzodiazepines= affect CNS can cause weakness/gait change
Successfully built into EMR with targeted interventions targeted.

12. For a Fall prevention program to be successful employees must?
COMMUNICATE
clearly with one another

13. summary
Risk from falling cannot be eliminated, however falls can be reduced by implementing an effective fall risk assessment tool. A culture of safety must be created in order to have positive outcomes and to improve quality of care.
Decrease falls by implementing Fall risk assessment

14. references
Gray-Miceli, D. (2007). Fall risk assessment for older adults: the Hendrich II Fall Risk Model. Try This: Best Practices In Nursing Care To Older Adults, (8). Kim, E., Mordiffi, S., Bee, W., Devi, K., & Evans, D. (2007). Evaluation of three fall-risk assessment tools in an acute care setting. Journal Of Advanced Nursing, 60(4), Nazarko, L. (2008). Falls part 4: prevention, assessment and intervention. British Journal Of Healthcare Assistants, 2(11), Nazarko, L. (2011). Falls: A momentary slip and a lifetime of consequences. British Journal Of Healthcare Assistants, 5(12), Stern C, Jayasekara R. Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic review. International Journal Of Evidence-Based Healthcare [serial online]. December 2009;7(4): Swann, J. (2010). Simple ways to prevent falls. British Journal Of Healthcare Assistants, 4(4), Tideiksaar, R. (2009). Chapter 8: falls. In B. Bonder, V. Dal Bello-Haas, M. Wagner (Eds.) , Functional Performance in Older Adults (3rd Edition) (pp ). Philadelphia, Pennsylvania: F.A. Davis Company. Titler, M. G., Shever, L. L., Kanak, M. F., Picone, D. M., & Qin, R. (2011). Factors associated with falls during hospitalization in an older adult population. Research & Theory For Nursing Practice, 25(2),