1. Clinical Process Guideline Evaluation of Falls/Fall Risk Deborah Ayers RN-MSN

2. Learning Objectives Following this presentation the audience will be able to: Following this presentation the audience will be able to: Verbalize the assessment/recognition of long term care risk for falls. Verbalize the assessment/recognition of long term care risk for falls. Verbalize possible causes of falls in long term care residents. Verbalize possible causes of falls in long term care residents. Verbalize cause specific interventions to prevent or minimize resident fall risk, falls and complications from falls. Verbalize cause specific interventions to prevent or minimize resident fall risk, falls and complications from falls. Will be able to verbalize methods of monitoring the resident’s response to fall interventions. Will be able to verbalize methods of monitoring the resident’s response to fall interventions.

3. Fall Definition “Any unplanned descent from a higher elevation to a lower elevation.” “Any unplanned descent from a higher elevation to a lower elevation.” Also count near- falls Also count near- falls Also count roll outs from a mattress on to the Also count roll outs from a mattress on to the floor floor

4. Falls Process Guidelines Assessment/Problem Definition Assessment/Problem Definition

5. Falls Process Guidelines Assessment/Problem Analysis Assessment/Problem Analysis History History External Factors External Factors Internal Factors Internal Factors

6. Falls Process Guidelines Assessment/Problem Analysis Assessment/Problem Analysis Refer to the (RAPs) for possible causes of falls Refer to the (RAPs) for possible causes of falls

7. Falls Process Guidelines Assessment/Problem Analysis Assessment/Problem Analysis Documentation of notification of physician/extender related to significance of falls or falls risk in the resident. Documentation of notification of physician/extender related to significance of falls or falls risk in the resident.

8. Falls Clinical Process Guidelines Diagnosis/Cause Identification Diagnosis/Cause Identification Identify and document risk factors in the RAP: External factors Identify and document risk factors in the RAP: External factors

9. Falls Process Guidelines Diagnosis/Cause Identification Diagnosis/Cause Identification Identify and document risk factors in the RAP: Internal factors Identify and document risk factors in the RAP: Internal factors

10. Falls Process Guidelines Diagnosis/Cause Identification Diagnosis/Cause Identification Physician or physician extender participates in the evaluation of the resident to identify the causes of falls or fall risks Physician or physician extender participates in the evaluation of the resident to identify the causes of falls or fall risks

11. Falls Clinical Process Guidelines Treatment/Problem Management Treatment/Problem Management Care plan should contain cause-specific interventions to prevent or minimize fall risk, falls, or complications from falls OR the care plan is modified to accommodate the expectation of continued risk. Care plan should contain cause-specific interventions to prevent or minimize fall risk, falls, or complications from falls OR the care plan is modified to accommodate the expectation of continued risk.

12. Falls Clinical Process Guidelines Treatment/Problem Management Treatment/Problem Management Documentation of the physician involvement in the development of cause-specific fall interventions. Documentation of the physician involvement in the development of cause-specific fall interventions.

13. Falls Clinical Process Guidelines Treatment/Problem Management Treatment/Problem Management If the resident falls, (without another obvious cause) the physician documentation should reflect a trail adjustment of medications or medication combinations. If the resident falls, (without another obvious cause) the physician documentation should reflect a trail adjustment of medications or medication combinations.

14. Falls Clinical Process Guidelines Treatment/Problem Management Treatment/Problem Management Is there evidence to indicate the care plan has been implemented? Is there evidence to indicate the care plan has been implemented?

15. Falls Clinical Process Guidelines Monitoring Monitoring Document monitoring of the resident’s response to interventions. Document monitoring of the resident’s response to interventions. Document a periodic review of approaches for applicability to the current situation. Document a periodic review of approaches for applicability to the current situation.

16. Falls Clinical Process Guidelines Monitoring Monitoring Care plan documentation that reflects previously selected interventions were re-evaluated if falling continued. Care plan documentation that reflects previously selected interventions were re-evaluated if falling continued.

17. Falls Clinical Process Guidelines Monitoring Monitoring After a fall associated with injury occurs documentation should reflect notification of the physician. After a fall associated with injury occurs documentation should reflect notification of the physician.

18. Falls Clinical Process Guidelines Monitoring Monitoring Document that actual consequences were addressed, based on prominence of s/s, with re-evaluation until stable. Document that actual consequences were addressed, based on prominence of s/s, with re-evaluation until stable.

19. Falls Clinical Process Guidelines Monitoring Monitoring Document observation for possible delayed consequences of a fall ( late evidence of fracture, subdural hematoma, etc.) for at least 48 hours). Document observation for possible delayed consequences of a fall ( late evidence of fracture, subdural hematoma, etc.) for at least 48 hours).

20. Falls Clinical Process Guidelines Monitoring Monitoring Documentation of staff awareness of policy/procedures for resident falls Documentation of staff awareness of policy/procedures for resident falls

21. References American Medical Directors Association & American Health Care Association Falls and Fall Risk Clinical Practice Guideline, 2003 American Medical Directors Association & American Health Care Association Falls and Fall Risk Clinical Practice Guideline, 2003 Joint Commission on Accreditation of Healthcare Organizations, Sentinel Event Alert, Issue 14, July 12, 2000. Joint Commission on Accreditation of Healthcare Organizations, Sentinel Event Alert, Issue 14, July 12, 2000. JSC, Ink. 1999 Update MDS User’s Manual V 2.0, Watertown, Maine JSC, Ink. 1999 Update MDS User’s Manual V 2.0, Watertown, Maine