1. 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

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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