1. ©2011 CareTrack Resources: Preventing Falls

2. ©2011 CareTrack Resources: Preventing Falls
Objectives
Describe the risk factors for falls
Implement effective interventions for preventing falls
Respond appropriately to fall hazards
©2011 CareTrack Resources: Preventing Falls

3. Why the Concern About Falls?
Falls impair our clients’ quality of life and health.
Falls are one of the major reasons that clients move from assisted living into skilled care.
Falls are responsible for many of the lawsuits filed against assisted living facilities.
©2011 CareTrack Resources: Preventing Falls

4. Just the Facts . . . From the CDC
Falls are the leading cause of injury death for people ages 65 and older.
The risk of falling increases with age.
Older adults are two to three times more likely to fall within the next year who have:
Fallen previously or
Who stumble frequently
©2008 CareTrack Resources: Preventing Falls

5. Just the Facts . . . From the CDC (cont.)
Fall-related death rates are on the rise.
Falls are the cause of a large proportion of fatal traumatic brain injuries among seniors.
Falls are responsible for at least 95% of hip fractures among older adults.
Fractures, lacerations, and head traumas caused by falls often cause an elderly person to lose functional abilities and develop other health problems.
©2011 CareTrack Resources: Preventing Falls

6. ©2011 CareTrack Resources: Preventing Falls
What Is a Fall, Anyway?
A fall is any sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground.
©2011 CareTrack Resources: Preventing Falls

7. Fall Response Protocol
If a Client Falls:
1. Observe for injuries such as:
Scrapes or abrasions
Bumps, swelling or bruises
Skin cuts or lacerations
Sprain or broken bones
Obvious bumps or bleeding from the head
©2008 CareTrack Resources: Preventing Falls

8. Fall Response Protocol
2. Call ambulance/EMT immediately and do not move client if there is:
Injury to the head (with or without visible signs)
Stomach trauma (with or without visible signs)
Signs of stroke (mouth drooping, slurred speech)
Inability to move one or more extremities
Inability to see, speak, or hear
Severe pain with movement; extremities at odd angles or misshapen
Uncontrolled bleeding or shock after initiating standard first aid care
©2008 CareTrack Resources: Preventing Falls

9. Fall Response Protocol (cont.)
Obtain vitals while waiting for EMT or after initiating first aid care. If possible, do not leave client alone.
Alert physician of fall, request guidance on transfer if necessary.
Alert family and/or personal representative.
Monitor post-fall for signs of distress if client not transported out of residence.
©2008 CareTrack Resources: Preventing Falls

10. Fall Response Protocol (cont.)
Document incident. Document emergency care given, response, outcome, and which individuals were notified.
Complete incident report and distribute according to policy.
©2008 CareTrack Resources: Preventing Falls

11. Fall Response Protocol (cont.)
Before the end of the shift the incident occurred on, the Residence Nurse will notify the Regional RN of incident according to policy, discuss previous falls experienced by the client during the past 60 days, and discuss client care needs and needed interventions. Regional Nurse will report all incidents to Risk Management/Quality & Clinical Services according to policy.
©2008 CareTrack Resources: Preventing Falls

12. Fall Response Protocol (cont.)
The Residence Nurse will consult with Administrator, who will evaluate incident for proper follow-up on:
Licensing/state reporting
Workers’ compensation
Client Service Plan Changes
Client Fall Prevention and Management Assessment
©2008 CareTrack Resources: Preventing Falls

13. Fall Risk Assessment Procedures
New clients will be screened for fall risk using the Fall Risk Assessment Scale within 72 hours of admission The RN or LPN will perform this assessment.
Clients at risk for falling will be re-screened every 90 days, or immediately when there is a change of condition that may affect the client’s risk for falling.
©2008 CareTrack Resources: Preventing Falls

14. Fall Risk Assessment Procedures (cont.)
Clients determined to be a fall risk will be identified as such on the MAR and the care plan in order to communicate this information to all staff.
The client and significant other(s) will be educated regarding falls.
©2008 CareTrack Resources: Preventing Falls

15. ©2008 CareTrack Resources: Preventing Falls
Risk Factors for Falls
These factors significantly increase an elderly person’s risk of falling:
The more risk factors, the higher the fall risk.
Being female and/or white
Having had a previous fall
Wearing glasses or having other visual problems
©2008 CareTrack Resources: Preventing Falls

16. Risk Factors for Falls (cont.)
Having lower body weakness or gait or balance problems
Having physical limitations
Having more than one chronic disease
Being confused or cognitively impaired
©2008 CareTrack Resources: Preventing Falls

17. Risk Factors for Falls (cont.)
Taking more than four medications or using psychoactive medications
Wearing shoes with thick, soft soles, like jogging shoes
©2008 CareTrack Resources: Preventing Falls

18. Risk Factors for Falls (cont.)
Having any of these conditions:
Parkinson’s disease
Neuromuscular disease
Urinary incontinence
Seizure disorder
Blood pressure that drops when standing up (postural hypotension)
©2008 CareTrack Resources: Preventing Falls

19. What If A Client is at Risk for Falls?
Preventative measures should be discussed with the client and/or family
Interventions should be planned
Preventative measures should be addressed on the care plan
Care plan should direct staff regarding safety monitoring and proactive measures to prevent falls
©2008 CareTrack Resources: Preventing Falls

20. Interventions to Prevent Falls
Just modifying the environment does not significantly reduce fall risk.
Effective interventions require multiple approaches.
©2008 CareTrack Resources: Preventing Falls

21. Effective Interventions to Prevent Falls
Exercises that improve lower body strength and balance reduce the risk of falls and fall-related injuries
Studies have shown that practicing Tai Chi can reduce falls
Progressive resistance training can increase strength and improve mobility
©2008 CareTrack Resources: Preventing Falls

22. Fall Interventions: Exercise
Although vigorous exercise reduces the risk of fall-related fractures among healthy seniors, it increases risk among those with functional limitations.
Older adults with functional limitations may require individualized exercise programs.
©2008 CareTrack Resources: Preventing Falls

23. Interventions to Prevent Falls
Reduce Dangers in the Physical Environment
Reduce environmental hazards, such as clutter, everywhere you find them.
Reduce clutter in the client’s room as much as possible.
Ensure that eyeglasses, dentures, hearing aid, telephone, and other essential items are within easy reach of the client’s bed and/or chair.
©2008 CareTrack Resources: Preventing Falls

24. Environmental Interventions
Arrange furniture in room to maintain clear pathways without protruding furniture or objects in traffic areas.
Ensure call light accessibility. Frequently remind clients to use the call light in the bathroom or anytime they become weak or need help.
Clean up spills promptly.
©2008 CareTrack Resources: Preventing Falls

25. Maintaining a Safe Environment
Increase the safety and fit of wheelchairs
Maintain assistive mobility devices in proper working order.
Check wheelchairs regularly to ensure that brakes work and lock properly.
Check walkers and canes regularly to ensure intact rubber tips.
©2008 CareTrack Resources: Preventing Falls

26. Medication Interventions
Limit the use of psychoactive drugs
Review medication regimens and modify when necessary (fewer meds are better when possible)
©2008 CareTrack Resources: Preventing Falls

27. Medication Interventions (cont.)
RN Med Review
Conduct careful review of medications. Look for medications that may cause:
Dizziness
Disorientation or confusion
Impaired memory or judgment
Unsteady gait, imbalance, or weakness
Drowsiness
Lack of coordination
Talk to physician about possible alternatives when such medications are in use.
©2008 CareTrack Resources: Preventing Falls

28. Physician Interventions
Physician Assessment
Report client’s risk for falls to physician.
Request physician evaluation of client and medications in light of risk.
©2008 CareTrack Resources: Preventing Falls

29. Interventions for Sensory and Blood Pressure Problems
Keep eyeglasses in good condition with current prescription.
Teach client to rise from the bed or chair slowly to prevent dizziness.
Remind clients to ask for help if they feel weak, dizzy, or lightheaded when getting up.
©2008 CareTrack Resources: Preventing Falls

30. Interventions for Confused Clients
Disoriented clients should be located in rooms closer to the front of the building when possible.
Repeatedly remind clients with dementia about the call light.
Make a plan for frequent monitoring of clients who have periods of confusion.
©2008 CareTrack Resources: Preventing Falls

31. Physical Mobility Interventions
Request physical therapy evaluation for assistive mobility devices, gait or device training, and/or therapy
Encourage client to participate in exercise sessions to strengthen muscles, improve balance, and practice gait training.
©2008 CareTrack Resources: Preventing Falls

32. Footwear Interventions
Advise and remind client to wear properly fitting shoes or slippers with a nonskid surface that won’t slip on the floor at all times.
Avoid shoes with thick, soft soles, like jogging shoes.
Clients should not wear socks without shoes, even when alone in their rooms.
©2008 CareTrack Resources: Preventing Falls
©2008 CareTrack Resources: Preventing Falls

33. Other Interventions to Prevent Falls
Calcium and vitamin D are critical at all ages to maintain healthy bones.
Offer hip pads to people who are at high risk of falling.
Hip protectors can effectively prevent most hip fractures
©2008 CareTrack Resources: Preventing Falls

34. Essential Interventions to Prevent Falls
Pay attention to individual clients’ needs
Identify people who are at risk for falls by performing screening assessments
Design interventions targeted for clients at the greatest risk for falls
Educate clients and families about risk factors for falls
©2008 CareTrack Resources: Preventing Falls

35. Intervening with Those at Risk
Responsibilities:
Every employee is responsible for identifying potential fall hazards and preventing falls when possible.
Notify the appropriate person if you see an unsafe condition that may lead to falls.
If you see an unsafe condition that you can fix immediately, such as a liquid on the floor, clean it up or fix it without delay (or notify appropriate personnel at once).
©2008 CareTrack Resources: Preventing Falls

36. Intervening with Those at Risk (cont.)
Client Environment:
All personnel are responsible for client safety and fall prevention.
All employees are encouraged to maintain a clutter-free environment and communicate condition changes or incidents to the nurse, administrator, and/or other appropriate personnel.
©2011 CareTrack Resources: Preventing Falls

37. ©2011 CareTrack Resources: Preventing Falls
Please Complete Test
and Evaluation.
Thank You.
©2011 CareTrack Resources: Preventing Falls
©2008 CareTrack Resources: Preventing Falls

38. ©2011CareTrack Resources: Preventing Falls
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©2011CareTrack Resources: Preventing Falls
©2008 CareTrack Resources: Preventing Falls