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Fall Prevention in Nursing Homes Nurse Aid Module Developed by: Duke University Medical Center School of Nursing, Center for Aging and Human Development, and the Durham VA GRECC
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Developed: 08-31-09 2 Contact: cathleen.colon- emeric@va.gov What do Nursing Assistants Need to Know about Preventing Falls? By the end of this course you will be able to:By the end of this course you will be able to: –List 3 things that can happen to residents because of falls. –Explain what a falls risk factor is, and how to look for it. –Describe ways nursing assistants help prevent falls when residents have trouble seeing, trouble walking, or unsafe behaviors. –Describe your role in working with co-workers to prevent falls.
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Developed: 08-31-09 3 Contact: cathleen.colon- emeric@va.gov Why Focus on Falls? 1.Falls cause serious injuries in older adults. 2.Many falls can be prevented. 3.You can make a difference by understanding: Why residents in nursing homes fall.Why residents in nursing homes fall. What to look for when you are on the unit.What to look for when you are on the unit. How your care helps prevent falls.How your care helps prevent falls.
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Developed: 08-31-09 4 Contact: cathleen.colon- emeric@va.gov Why are falls a problem? Did you know that one-half of the people living in nursing homes fall each year?Did you know that one-half of the people living in nursing homes fall each year? Did you know that 1 out of 10 falls causes a serious injury, such as a broken bone?Did you know that 1 out of 10 falls causes a serious injury, such as a broken bone? Did you know that many falls can be prevented?Did you know that many falls can be prevented?
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Developed: 08-31-09 5 Contact: cathleen.colon- emeric@va.gov Not all residents will fall.Not all residents will fall. To figure out who to watch out for, we look for risk factors.To figure out who to watch out for, we look for risk factors. A risk factor is something about a resident that makes it more likely for him or her to fall.A risk factor is something about a resident that makes it more likely for him or her to fall. The more risk factors a person has, the more likely they are to fall.The more risk factors a person has, the more likely they are to fall. We can reduce falls by noticing risk factors, and doing something about them.We can reduce falls by noticing risk factors, and doing something about them. Who is likely to fall?
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Developed: 08-31-09 6 Contact: cathleen.colon- emeric@va.gov Some fall risk factors can be learned about from past problems.Some fall risk factors can be learned about from past problems. Write down the numbers below that you think are risk factors for falls:Write down the numbers below that you think are risk factors for falls: 1.The resident has already had a fall. 2.The resident has had a stroke. 3.The resident cannot see well. 4.The resident has poor memory. What are some risk factors for falls?
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Answers 1.The resident has already had a fall. Right! A prior fall is the most important risk factor for another. 2.The resident has had a stroke. Yes. Strokes and other kinds of brain problems can cause falls 3.The resident cannot see well. Correct. 4.The resident has poor memory. Right. They might do unsafe things because of their poor memory.
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Developed: 08-31-09 8 Contact: cathleen.colon- emeric@va.gov What other risk factors should I look for? Other falls risk factors have to be observed. Do any of the residents you care for:Other falls risk factors have to be observed. Do any of the residents you care for: –Have incontinence? –Become dizzy when standing? –Hold onto furniture when walking? –Shuffle their feet? Nursing assistants are with residents more than most CLC staff, so you can observe risk factors before anyone else!Nursing assistants are with residents more than most CLC staff, so you can observe risk factors before anyone else!
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Developed: 08-31-09 9 Contact: cathleen.colon- emeric@va.gov How many falls risk factors do you see? Scenario 1 Mr. Jones was admitted today. The charge nurse tells you he had a stroke 2 years ago.Mr. Jones was admitted today. The charge nurse tells you he had a stroke 2 years ago. After lunch, Mr. Jones says he wants to go back to bed. When he stands up, he complains he is dizzy. He holds onto the dining room chairs as he walks to his room.After lunch, Mr. Jones says he wants to go back to bed. When he stands up, he complains he is dizzy. He holds onto the dining room chairs as he walks to his room. Write down the number of each falls risk factor you see in Mr. Jones:Write down the number of each falls risk factor you see in Mr. Jones: 1.Holding onto furniture. 2.History of stroke. 3.History of falls. 4.Unsteady walking. 5.Wanting to go to bed after lunch. 6.Being dizzy.
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Answers 1.Holding onto furniture. Good. This is a sign of poor balance 2.History of stroke. Right. 3.History of falls. Falls are an important risk factor, but we don’t know that Mr. Jones has had prior falls. 4.Unsteady walking. Yes. 5.Wanting to go to bed after lunch. No, this is not necessarily a risk for falls. 6.Being dizzy. Good. His blood pressure might be dropping, or dizziness might affect his balance.
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Developed: 08-31-09 11 Contact: cathleen.colon- emeric@va.gov What do we do about fall risk factors when we notice them? We’ve just learned that there are a lot of risk factors for falls. But just noticing the risk factors won’t keep the resident from falling. We have to do something about them.We’ve just learned that there are a lot of risk factors for falls. But just noticing the risk factors won’t keep the resident from falling. We have to do something about them. Let’s take a look at the risk factors that nursing assistants can do something about.Let’s take a look at the risk factors that nursing assistants can do something about.
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Developed: 08-31-09 12 Contact: cathleen.colon- emeric@va.gov Orthostatic Vital Signs (Blood pressure drops) In many older people, blood pressure drops a lot when they sit or stand. This can cause dizziness and falls.In many older people, blood pressure drops a lot when they sit or stand. This can cause dizziness and falls. Dropping blood pressure is called “orthostasis.”Dropping blood pressure is called “orthostasis.” Dropping blood pressure can be caused by dehydration (not having enough fluids), medicines, or medical problems.Dropping blood pressure can be caused by dehydration (not having enough fluids), medicines, or medical problems. You can help identify dropping blood pressure by measuring “orthostatic vitals signs.”You can help identify dropping blood pressure by measuring “orthostatic vitals signs.”
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Developed: 08-31-09 13 Contact: cathleen.colon- emeric@va.gov How to Take Orthostatic Vital Signs 1.Have the patient lie down for 5 minutes. 2.Take the patient’s BP and pulse. 3.Have the patient sit up on the side of the bed with their legs hanging over the edge. 4.Take the BP and pulse again right away. 5.If they can stand up, take the BP and pulse again right away. Report if you see: A drop in BP more than 20 points, orA drop in BP more than 20 points, or An increase in pulse more than 20 beats per minute.An increase in pulse more than 20 beats per minute.
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Developed: 08-31-09 14 Contact: cathleen.colon- emeric@va.gov The nurse asks you to “check orthostatics” on Mr. Jones. Which is the best way to do it? 1.Take his BP while he is sitting in his wheelchair, then lie him down and do it again 5 minutes later. 2.Take his BP and pulse after he has been lying down for at least 5 minutes, then elevate the head of his bed and measure BP and pulse again. 3.Take his BP and pulse after he has been lying down for at least 5 minutes, then stand him up and immediately repeat the BP and pulse measurement. Does Mr. Jones’ blood pressure drop too much? Scenario 2
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Answer 3.Take his BP and pulse after he has been lying down for at least 5 minutes, then stand him up and immediately repeat the BP and pulse measurement. Don’t make these common mistakes:Don’t make these common mistakes: Taking the sitting blood pressure firstTaking the sitting blood pressure first Just elevating the head of the bed, without letting his or her legs dangle over the sideJust elevating the head of the bed, without letting his or her legs dangle over the side
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Developed: 08-31-09 16 Contact: cathleen.colon- emeric@va.gov Mr. Jones’ BP drops from 160/90 to 125/70 when he stands up. What should you do? 1.Nothing, it can’t be helped. 2.Let the nurse and medical team know, so that they can review his medications and check for other problems. 3.Put compression stockings on Mr. Jones every morning. 4.When you get Mr. Jones up each day, have him sit on the edge of the bed for a few minutes, and provide extra assistance when he stands. Ask the other NAs to do this too. 5.Encourage Mr. Jones to drink plenty of fluids throughout the day. Should you bother the charge nurse? Scenario 3
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Answers 1.Nothing, it can’t be helped. No! 2.Let the nurse and medical team know, so that they can review his medications and check for other problems. Good. 3.Put compression stockings on Mr. Jones every morning. Great idea. 4.When you get Mr. Jones up each day, have him sit on the edge of the bed for a few minutes, and provide extra assistance when he stands. Ask the other NAs to do this too. Excellent. 5.Encourage Mr. Jones to drink plenty of fluids throughout the day. Right. Don’t forget to tell the other NAs who work with Mr. Jones about these ideas too.
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Developed: 08-31-09 18 Contact: cathleen.colon- emeric@va.gov Reducing Falls Risk Factors: The Nursing Assistant’s Role Let’s think about how nursing assistants can reduce falls for residents who: –Can’t see clearly. –Have problems moving around safely. –Do unsafe things.
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Developed: 08-31-09 19 Contact: cathleen.colon- emeric@va.gov –Turn on the lights in the bedroom or bathroom, or open up the blinds. –Ask the resident if they can see better after you turn on the lights. If not, you may need to adjust the blinds or try different lighting. –Keep the resident’s eyeglasses within reach at all times. –You may need to remind the resident to wear their glasses. –Let the nurse or medical team know if the resident is seeing poorly, so that they can make sure his eye exam is up to date. How can I help a resident who doesn’t see well?
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Developed: 08-31-09 20 Contact: cathleen.colon- emeric@va.gov How can I help a resident who doesn’t walk well? Scenario 4 Watch Mr. Jones walk by double-clicking the box to the right.Watch Mr. Jones walk by double-clicking the box to the right. Write down at least 2 things you could do to help him.Write down at least 2 things you could do to help him.
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Developed: 08-31-09 21 Contact: cathleen.colon- emeric@va.gov How can I help a resident who doesn’t walk well? Mr. Jones’ walking is not safe because his legs are weak. Here are some things you can do to help him: Mr. Jones’ walking is not safe because his legs are weak. Here are some things you can do to help him: Ask if the physical therapist can see him for leg strengthening exercises.Ask if the physical therapist can see him for leg strengthening exercises. Stand by to give him extra assistance when he walks.Stand by to give him extra assistance when he walks. Adjust the height of his bed, chair, and toilet so that they are knee height or a little higher.Adjust the height of his bed, chair, and toilet so that they are knee height or a little higher.
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Developed: 08-31-09 22 Contact: cathleen.colon- emeric@va.gov Adjusting Bed, Chair, and Toilet Height www.contextualise.com/image/img/Sticktostand.jpg Patient’s thighs are level when their feet are flat on the floor
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Developed: 08-31-09 23 Contact: cathleen.colon- emeric@va.gov Unsafe behaviors often cause residents to fall. Here are some unsafe behaviors you should watch for in Mr. Jones. –He often tries to stand and walk alone. –He tries to climb over his bed rails. –He walks and paces, even though he seems very tired. –He was outside walking alone on rough ground and in the parking lot. How can I help a resident with unsafe behavior?
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Developed: 08-31-09 24 Contact: cathleen.colon- emeric@va.gov When residents show unsafe behaviors, staff may need to get creative to find ways to reduce falls. Write down 1 creative idea for how you might do the following:When residents show unsafe behaviors, staff may need to get creative to find ways to reduce falls. Write down 1 creative idea for how you might do the following: –Watch and assist more. –Prevent an injury. –Make residents more comfortable. The next slides show some ideas. Was yours on there?The next slides show some ideas. Was yours on there? How can I help a resident with unsafe behaviors? Scenario 5
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Developed: 08-31-09 25 Contact: cathleen.colon- emeric@va.gov Unsafe behaviors: Watch and Assist More Use bed and chair alarms.Use bed and chair alarms. Take them to the toilet every 2 hours.Take them to the toilet every 2 hours. Take them to activity programs.Take them to activity programs. Keep patient near the nursing station.Keep patient near the nursing station.
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Developed: 08-31-09 26 Contact: cathleen.colon- emeric@va.gov Unsafe Behaviors: Prevent an Injury Lower the bed, put down a floor matLower the bed, put down a floor mat Get rid of bed side railsGet rid of bed side rails Put on non-skid socks or shoesPut on non-skid socks or shoes Put non-skid mat on the floorPut non-skid mat on the floor Put on hip protectorsPut on hip protectors
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Developed: 08-31-09 27 Contact: cathleen.colon- emeric@va.gov Unsafe Behaviors: Make them More Comfortable Report signs of painReport signs of pain Put them in a recliner or rocking chairPut them in a recliner or rocking chair Take them for exerciseTake them for exercise Use a special mattress, sheepskin, or pillowsUse a special mattress, sheepskin, or pillows
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Developed: 08-31-09 28 Contact: cathleen.colon- emeric@va.gov Because there are so many fall risk factors, the staff will need to work together to prevent Mr. Jones from falling. Select all the people who might need to do something to keep him from falling. Because there are so many fall risk factors, the staff will need to work together to prevent Mr. Jones from falling. Select all the people who might need to do something to keep him from falling. –The nurses’ assistants –The direct care nurses –The Rehabilitation staff –The medical team –The pharmacist –Housekeeping and Maintenance –Activities –Patients and Families Right! Everyone needs to be involved in fall preventionRight! Everyone needs to be involved in fall prevention The Falls Prevention Team
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What do nursing assistants do to prevent falls? Watch for Fall Risk Factors Measure Orthostatic Blood Pressure Vision Lighting Glasses Glare Walking PT Seat height Toileting Unsafe Behavior Assistance Prevent Injury Comfort
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Developed: 08-31-09 30 Contact: cathleen.colon- emeric@va.gov If you want to learn more about preventing falls… Talk to your Facility’s Falls Coordinator or Supervisor about how you can get more involved in fall prevention efforts.Talk to your Facility’s Falls Coordinator or Supervisor about how you can get more involved in fall prevention efforts. Useful resources:Useful resources: –AHRQ innovations site http://www.innovations.ahrq.gov/content.aspx?id=2052 http://www.innovations.ahrq.gov/content.aspx?id=2052 –Falls Management Program http://www.qualitynet.org/dcs/ContentServer?cid=113649577110 4&pagename=Medqic/MQTools/ToolTemplate&c=MQTools http://www.qualitynet.org/dcs/ContentServer?cid=113649577110 4&pagename=Medqic/MQTools/ToolTemplate&c=MQTools
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Developed: 08-31-09 31 Contact: cathleen.colon- emeric@va.gov The End Please close this presentation and begin the quiz.
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