FALLS MANAGEMENT FALLS MANAGEMENT

Technical Assistance Program (TAP)Ohio Department of Health

Division of Quality Assurance

What Will We Do Today?What Will We Do Today?

Discuss:Discuss:

What is a fall?What is a fall?Who is at risk?Who is at risk?What could the causes be?What could the causes be?Ideas for investigationIdeas for investigationWhat interventions/care planning could help?What interventions/care planning could help?Possible ways to approach falls as a facilityPossible ways to approach falls as a facilityIdeas for assuring that interventions are in placeIdeas for assuring that interventions are in placeWhen will you re-evaluate the resident?When will you re-evaluate the resident?How will you know that your program is working?How will you know that your program is working?

What Is A Fall?What Is A Fall?

A fall, as defined by the MDS, includes the A fall, as defined by the MDS, includes the following:following:

An intercepted fall is still a fall.An intercepted fall is still a fall.

A fall without an injury is still a fall.A fall without an injury is still a fall.

When found on the floor, unless there isWhen found on the floor, unless there is evidence to suggest something else, the evidence to suggest something else, the most logical conclusion is that it was a fall.most logical conclusion is that it was a fall.

The distance to the next lower surface is not a The distance to the next lower surface is not a factor in determining if a fall occurred or not. factor in determining if a fall occurred or not. (Rolling off the bed or mattress that is close to(Rolling off the bed or mattress that is close to the floor is still a fall)the floor is still a fall)

The point of calling these incidences a fall is to The point of calling these incidences a fall is to identify and communicate resident problems or identify and communicate resident problems or potential problems so that staff will consider and potential problems so that staff will consider and implement interventions.implement interventions.

(RAI Version 2.0 Manual) – revised December 2002 – page 3-146 – 3-147(RAI Version 2.0 Manual) – revised December 2002 – page 3-146 – 3-147

What Is A Fall? (Continued)What Is A Fall? (Continued)

Approximately 51% of residents in LTC fall annually Approximately 51% of residents in LTC fall annually

About 10% to 20% of nursing home falls cause About 10% to 20% of nursing home falls cause serious injuryserious injury

About 1800 fatal falls occur among nursing home About 1800 fatal falls occur among nursing home residents in the U.S. each yearresidents in the U.S. each year

Two thirds of lawsuits filed against nursing homes Two thirds of lawsuits filed against nursing homes are associated with falls and related fracturesare associated with falls and related fractures

Why Study Falls?Why Study Falls?

Consequences of FallsConsequences of Falls

Mild to severe injuryMild to severe injury

Increased morbidity and mortalityIncreased morbidity and mortality

Loss of independenceLoss of independence

FearFear

Decreased activityDecreased activity

Decreased quality of lifeDecreased quality of life

Changing Our ThinkingChanging Our ThinkingFalls are no longer assumed to be “accidents” Falls are no longer assumed to be “accidents” that either can not be prevented or are due to the that either can not be prevented or are due to the faller.faller.

Falls research indicates falls are a “non-specific Falls research indicates falls are a “non-specific sign or symptom” that represents an underlying sign or symptom” that represents an underlying condition.condition.

Most falls are due to a combination of physical, Most falls are due to a combination of physical, life-style, environmental and social factors that life-style, environmental and social factors that can be assessed and may be modified to can be assessed and may be modified to decrease fall risks.decrease fall risks.

Alabama Quality Assurance FoundationAlabama Quality Assurance Foundation

08/06/0108/06/01

Initial Fall AssessmentInitial Fall Assessment Comprehensive and as immediate as possible Comprehensive and as immediate as possible the day of admission the day of admission

Would include all the known high risk Would include all the known high risk factors/categories factors/categories

Initiation of immediate interventions for each Initiation of immediate interventions for each individual risk identified individual risk identified

It may be necessary to initiate interventions until It may be necessary to initiate interventions until more resident behaviors and habits can be more resident behaviors and habits can be observed by monitoring observed by monitoring

Fall Assessment/Re-assessmentFall Assessment/Re-assessment

Initial MDS Initial MDS

QuarterlyQuarterly

After each fallAfter each fall

Change of condition or function, new acute illness Change of condition or function, new acute illness or worsening of any diagnoses, new or increased or worsening of any diagnoses, new or increased painpain

Fall Assessment/Re-assessmentFall Assessment/Re-assessment(Continued)(Continued)

Review all interventions that are in place and if Review all interventions that are in place and if they are working. they are working.

Make changes to those that are no longer Make changes to those that are no longer effective. effective.

Implement new interventions according to Implement new interventions according to individual risk and “R” behaviors that have been individual risk and “R” behaviors that have been identified.identified.All of the same risk factor categories should be All of the same risk factor categories should be reassessed. reassessed. In addition, all previous falls for each individual In addition, all previous falls for each individual resident should be reviewed to identify the resident should be reviewed to identify the specific cause of the fall for this resident.specific cause of the fall for this resident.

Fall Risk Assessment and ToolsFall Risk Assessment and Tools

Some facilities utilize a point system to Some facilities utilize a point system to assign fall riskassign fall risk

Some facilities initiate standardized Some facilities initiate standardized interventions for those residents identified interventions for those residents identified as being at risk for falls.as being at risk for falls.

Categories of Risk Factors Categories of Risk Factors Known to Cause Falls:Known to Cause Falls:

Fall HistoryFall History

Social Needs/Motivation Social Needs/Motivation for Movingfor Moving

Mental/Cognitive StatusMental/Cognitive Status

Ambulation/Gait AbilityAmbulation/Gait Ability

Standing/Transfer AbilityStanding/Transfer Ability

Bowel/Bladder Bowel/Bladder ContinenceContinence

Wandering BehaviorWandering Behavior

Adaptive EquipmentAdaptive Equipment

FootwearFootwear

Bed/Chair Bed/Chair

VisionVision

Change in ConditionChange in Condition

MedicationsMedications

DiagnosesDiagnoses

Fall HistoryFall History

““R” has had no prior fallsR” has had no prior falls““R” is a new admission within the first 72 hoursR” is a new admission within the first 72 hours““R” has a known history of falls with the R” has a known history of falls with the likelihood of falling again likelihood of falling again ““R’ has the likelihood of falling again for the R’ has the likelihood of falling again for the same reasonsame reason““R” has a history of falls with various injuriesR” has a history of falls with various injuries““R” frequently falls, but no injuries thus farR” frequently falls, but no injuries thus far““R” has an increase in frequency of fallingR” has an increase in frequency of falling““R” has a diagnosis of Osteoporosis increasing R” has a diagnosis of Osteoporosis increasing risk of fracture and has a frequent fall historyrisk of fracture and has a frequent fall history

Social Needs/Motivation For Social Needs/Motivation For MovingMoving

““R” has never slept well at nightR” has never slept well at night

““R” worked the afternoon shift and did not R” worked the afternoon shift and did not go to sleep till after midnightgo to sleep till after midnight

Resident worked the night shiftResident worked the night shift

““R” woke early routinely for any variety of R” woke early routinely for any variety of reasons (farmer, fixed spouse breakfast, reasons (farmer, fixed spouse breakfast, etc.)etc.)

Mental/Cognitive Status Mental/Cognitive Status

““R” has no cognitive impairmentR” has no cognitive impairment

““R” has recall problemsR” has recall problems

““R” has impaired short term memoryR” has impaired short term memory

““R” mental status varies over the course of the R” mental status varies over the course of the dayday

““R” is unable to understand/comprehendR” is unable to understand/comprehend

““R” consistently knows own safety needs: Y NR” consistently knows own safety needs: Y N

““R” consistently knows their own abilities: Y NR” consistently knows their own abilities: Y N

Ambulation/Gait AbilityAmbulation/Gait Ability

““R” has a steady gaitR” has a steady gait““R” is dependent, but will call for assistanceR” is dependent, but will call for assistance““RS” gait is unsteady, but will call for assistanceRS” gait is unsteady, but will call for assistance““Rs” gait is unsteady, but usual for the resident – Rs” gait is unsteady, but usual for the resident – no fallsno falls““Rs” gait is unsteady, has a history of falls, and Rs” gait is unsteady, has a history of falls, and does not remember to call for assistance or will does not remember to call for assistance or will not call for assistancenot call for assistanceIs this “R” safe to be left alone in the bathroom? Is this “R” safe to be left alone in the bathroom? Yes or NoYes or No

Standing/Transfer AbilityStanding/Transfer Ability

““R” is able to stand/transfer independently R” is able to stand/transfer independently

““R” is unable to stand/transfer unassistedR” is unable to stand/transfer unassisted

““R” is unable to stand/transfer unassisted and R” is unable to stand/transfer unassisted and makes attempts to get upmakes attempts to get up

““R’ is unable to stand/transfer unassisted and R’ is unable to stand/transfer unassisted and does not remember to call for assistancedoes not remember to call for assistance

““R” is unable to stand/transfer unassisted, but R” is unable to stand/transfer unassisted, but makes no attempts to get upmakes no attempts to get up

““R” is continent R” is continent ““R” is known to be incontinentR” is known to be incontinent““R” manages incontinence per self with steady R” manages incontinence per self with steady gaitgait““R” attempts to manage incontinence per self R” attempts to manage incontinence per self with unsteady gait and/or memory problemswith unsteady gait and/or memory problems““R” is incontinent, but will wait and call for assist R” is incontinent, but will wait and call for assist to toiletto toilet““R” has a new order or an increased dose of a R” has a new order or an increased dose of a diuretic diuretic

Bowel/Bladder ContinenceBowel/Bladder Continence

Wandering BehaviorWandering Behavior

““Rs” gait is steady when wanderingRs” gait is steady when wandering

““Rs” gait becomes unsteady when resident Rs” gait becomes unsteady when resident becomes tiredbecomes tired““R” is unable to identify when tired or when gait R” is unable to identify when tired or when gait becomes unsteadybecomes unsteady

Adaptive Equipment (cane, Adaptive Equipment (cane, walkers, special shoes, etc.)walkers, special shoes, etc.)

““R” utilizes the ambulatory aide correctlyR” utilizes the ambulatory aide correctly

““R” utilizes the ambulatory aide correctly with a R” utilizes the ambulatory aide correctly with a steady gaitsteady gait

““R” utilizes the ambulatory aide incorrectly, but R” utilizes the ambulatory aide incorrectly, but with a steady gaitwith a steady gait

““R” utilizes the ambulatory aide incorrectly with R” utilizes the ambulatory aide incorrectly with an unsteady gaitan unsteady gait

Footwear (fit, heel height, Footwear (fit, heel height, soles, stockings, socks)soles, stockings, socks)

““Rs” shoes appear to fit and no other shoe problems are Rs” shoes appear to fit and no other shoe problems are notednoted

““Rs” shoes do not appear to fit Rs” shoes do not appear to fit

““Rs” heel height does not cause an unsteady gait or Rs” heel height does not cause an unsteady gait or potential for an unsteady gaitpotential for an unsteady gait

““Rs” thick rubber type soles may stick during ambulationRs” thick rubber type soles may stick during ambulation

““Rs” thick soles may not allow for distinction of floor Rs” thick soles may not allow for distinction of floor transitionstransitions

““Rs” soles may be slick on wet or non-carpeted floorsRs” soles may be slick on wet or non-carpeted floors

““R” wears stockings or socks that would be slick on non-R” wears stockings or socks that would be slick on non-carpeted floorscarpeted floors

Bed/Chair Bed/Chair

““Rs” feet can touch the floor when sitting on the Rs” feet can touch the floor when sitting on the side of the bedside of the bed

““Rs” feet can touch the floor when in a specified Rs” feet can touch the floor when in a specified chairchair

““Rs” feet can touch the floor when in the chair in Rs” feet can touch the floor when in the chair in his/her roomhis/her room

““Rs” chair has no arms and the “R” falls asleep Rs” chair has no arms and the “R” falls asleep while sitting, leans or is unsteady when rising while sitting, leans or is unsteady when rising from a chair.from a chair.

““R” sits in proper body alignment (three right R” sits in proper body alignment (three right angles – hip, knee, ankle)angles – hip, knee, ankle)

Vision (glasses)Vision (glasses)““R” has glassesR” has glasses““Rs” glasses are for distance or just for reading?Rs” glasses are for distance or just for reading?If for distance and need to be worn, “R” wears If for distance and need to be worn, “R” wears them without removing themthem without removing themIf for distance and need to be worn, “R” wears If for distance and need to be worn, “R” wears them but removes them and forgets to put them them but removes them and forgets to put them back onback on““R” has an unsteady gait without glasses onR” has an unsteady gait without glasses on““R” almost misses the edge of the chair/bed R” almost misses the edge of the chair/bed when sittingwhen sitting

Change in ConditionChange in Condition

““R’ has no change in their cognitive statusR’ has no change in their cognitive status

““Rs” cognitive status has changed – complete Rs” cognitive status has changed – complete another full fall risk assessmentanother full fall risk assessment

““Rs” functional status has changed – complete Rs” functional status has changed – complete another full fall risk assessmentanother full fall risk assessment

““R” has pain: new or increasedR” has pain: new or increased

““R” has a new acute illnessR” has a new acute illness

““R” has a worsening of any diagnosisR” has a worsening of any diagnosis

““R” has new low blood pressureR” has new low blood pressure

Medications Medications

““R” is receiving no new or changed medicationsR” is receiving no new or changed medications

““R” is receiving new medicationsR” is receiving new medications

““R” is receiving new medications with side effects R” is receiving new medications with side effects that may contribute to fallsthat may contribute to falls

““R” is receiving an increased dose of medication R” is receiving an increased dose of medication with side effects that may contribute to fallswith side effects that may contribute to falls

Types of medications that may contribute to falls: Types of medications that may contribute to falls:

antipsychotics, anti-anxieties, hypnotics, anti-antipsychotics, anti-anxieties, hypnotics, anti-

depressants, cardiovascular, laxatives and diureticsdepressants, cardiovascular, laxatives and diuretics

DiagnosesDiagnoses

““R” has a diagnosis of Seizures – controlled or R” has a diagnosis of Seizures – controlled or uncontrolleduncontrolled““R” has a diagnosis of Stroke – what has been R” has a diagnosis of Stroke – what has been affected – memory, behavior, legs, arms, hands, affected – memory, behavior, legs, arms, hands, etc.etc.““R” has a diagnosis of Parkinson’s, Huntington’s R” has a diagnosis of Parkinson’s, Huntington’s Chorea, Multiple Sclerosis – stable or changingChorea, Multiple Sclerosis – stable or changing““R” has a diagnosis of Vertigo – controlled or R” has a diagnosis of Vertigo – controlled or uncontrolleduncontrolled““R” has a history of Cardiac Arrhythmias/Anemia R” has a history of Cardiac Arrhythmias/Anemia – controlled or uncontrolled heart rate or B/P– controlled or uncontrolled heart rate or B/P

A Different LookA Different Look

Risk Factors – Individualized InterventionsRisk Factors – Individualized Interventions

ConsistencyConsistency– In-serviceIn-service– AlgorithmsAlgorithms– ProtocolsProtocols– Flow ChartsFlow Charts– ToolsTools– Etc.Etc.

Case StudyCase Study

HistoryHistory: 84 year old female with cognitive impairment : 84 year old female with cognitive impairment admitted one month ago for strengthening after admitted one month ago for strengthening after exacerbation of CHF.exacerbation of CHF.

DiagnosesDiagnoses: Alzheimer’s Disease, Congestive Heart : Alzheimer’s Disease, Congestive Heart Failure (CHF), Glaucoma and Arthritis.Failure (CHF), Glaucoma and Arthritis.

AdmissionAdmission: Ambulates with a walker and needs to be : Ambulates with a walker and needs to be reminded to use her walker. Physical Therapy three reminded to use her walker. Physical Therapy three times a week. Two days ago discharged to restorative times a week. Two days ago discharged to restorative nursing. Wears prescribed shoes to aid balance.nursing. Wears prescribed shoes to aid balance.

Social HistorySocial History: Husband died 1 month prior to : Husband died 1 month prior to admission. Dementia began after husband’s death. admission. Dementia began after husband’s death. Husband worked on the railroad and had to be at work Husband worked on the railroad and had to be at work at 5:00 am. Mrs. Anderson arose every morning at at 5:00 am. Mrs. Anderson arose every morning at 4:00 am to cook breakfast. 4:00 am to cook breakfast.

Case Study (Continued)Case Study (Continued)Nursing AssessmentNursing Assessment

Usually continent, but has occasional episodes of Usually continent, but has occasional episodes of incontinence. Ambulates and toilets self.incontinence. Ambulates and toilets self.Not oriented to day and time. Forgets that her Not oriented to day and time. Forgets that her husband has died.husband has died.Eats 50% of meals and needs reminded to drink fluids.Eats 50% of meals and needs reminded to drink fluids.Fall risk care plan: Remind to use walker; make sure Fall risk care plan: Remind to use walker; make sure she wears glasses; place shoes within reach. she wears glasses; place shoes within reach. Previous fall one week ago. Found on the floor beside Previous fall one week ago. Found on the floor beside her bed at 4:00 a.m. Added to care plan after fall: her bed at 4:00 a.m. Added to care plan after fall: Remind to call for help at night when getting out of Remind to call for help at night when getting out of bed.bed.

Fall Scene InformationFall Scene InformationSTNA who found resident: Resident was found on STNA who found resident: Resident was found on the floor by her bed when doing hourly checks at the floor by her bed when doing hourly checks at 5:00 a.m. Observed one of the resident’s shoes to 5:00 a.m. Observed one of the resident’s shoes to be on and the other to be off. There was a wet area be on and the other to be off. There was a wet area on the floor underneath her. The resident told the on the floor underneath her. The resident told the STNA that her husband needed to have his STNA that her husband needed to have his breakfast and she was going to the kitchen.breakfast and she was going to the kitchen.Scene: Glasses were broken and were found on the Scene: Glasses were broken and were found on the floor beside her. The tissue around the resident’s floor beside her. The tissue around the resident’s left eye was red and swollen. The resident’s walker left eye was red and swollen. The resident’s walker tip was found in the corner of the room.tip was found in the corner of the room.Roommate: Saw resident having difficulty putting Roommate: Saw resident having difficulty putting her shoes on. The resident’s glasses are always her shoes on. The resident’s glasses are always dirty. I’ve never seen her use the call bell. Her dirty. I’ve never seen her use the call bell. Her walker looks wobbly.walker looks wobbly.

Ideas For InvestigationIdeas For Investigation

Assess for:Assess for:– All risk factorsAll risk factors– Vital signsVital signs– InjuryInjury

Evaluate for painEvaluate for pain

Look at the environment (clutter/equipment)Look at the environment (clutter/equipment)

Describe the fall sceneDescribe the fall scene

What was the resident attempting to doWhat was the resident attempting to do

Ideas For Investigation (Continued)Ideas For Investigation (Continued)

Was the resident incontinentWas the resident incontinent

Evaluate the equipment being usedEvaluate the equipment being used

Interview all staffInterview all staff

Don’t forget to interview family membersDon’t forget to interview family members

Review previous fall data for this residentReview previous fall data for this resident

Evaluate previous social historyEvaluate previous social history

Review the plan of careReview the plan of care

Ideas For Investigation (Continued)Ideas For Investigation (Continued)Review the incident report – did it work for you?Review the incident report – did it work for you?

Consider including on your incident/investigation report the Consider including on your incident/investigation report the following:following:

– Open ended interview questions to family and resident Open ended interview questions to family and resident – Asking Staff: What do you think caused this fall? What Asking Staff: What do you think caused this fall? What

was implemented to prevent a repeat fall from the same was implemented to prevent a repeat fall from the same cause?cause?

– Time of last mealTime of last meal– Time of dayTime of day– Medications received prior to fallMedications received prior to fall– Glare or wet floorGlare or wet floor– New furniture arrangementNew furniture arrangement– Foot wearFoot wear– Was the resident in a crowd of peopleWas the resident in a crowd of people

Ideas For Investigation (Continued)Ideas For Investigation (Continued)

Make appropriate referralsMake appropriate referrals

Add to tracking systemAdd to tracking system

Put monitoring system in placePut monitoring system in place

- - to communicate interventionsto communicate interventions

-- to assure that placement of interventions is to assure that placement of interventions is monitoredmonitored

Tracking SystemTracking System

Keep a spreadsheet with the information you needKeep a spreadsheet with the information you needExamples:Examples:– ResidentResident– Location of fallLocation of fall– Time of fallTime of fall– Type of adaptive equipment usedType of adaptive equipment used– Any other information you want to collectAny other information you want to collect (ie: incontinent at time of fall, foot wear in use, type of (ie: incontinent at time of fall, foot wear in use, type of

floor surface where fall occurred, call light within reach floor surface where fall occurred, call light within reach and functioning or not)and functioning or not)

– What new interventions were institutedWhat new interventions were instituted

Care PlanCare Plan

WorkableWorkable

UsableUsable

Up-to-dateUp-to-date

Ideas to address the execution Ideas to address the execution GAP!!GAP!!

Use back of wardrobe to list interventionsUse back of wardrobe to list interventionsHold in-services regarding specific residents and Hold in-services regarding specific residents and their individualized interventionstheir individualized interventionsHave a check-off list for staff to use – computer Have a check-off list for staff to use – computer or otherwiseor otherwisePlace the check-off list on a clip board at the Place the check-off list on a clip board at the nurses’ stationnurses’ stationStaff member (designated or administrative) Staff member (designated or administrative) check for presence of interventions (monitoring)check for presence of interventions (monitoring)Will there be consequences for the staff if the Will there be consequences for the staff if the interventions are not in place?interventions are not in place?

Falls PreventionFalls Prevention Performance Improvement Project Performance Improvement Project Implementation Strategies for Most Implementation Strategies for Most

Popular SolutionsPopular Solutions

Implementing a falls decision guideImplementing a falls decision guideUsing an internet bulletin board to solicit ideas regarding Using an internet bulletin board to solicit ideas regarding how to care for frequent fallers through Ohio KePRO how to care for frequent fallers through Ohio KePRO Keeping fall diaries for each resident using an Excel Keeping fall diaries for each resident using an Excel spreadsheetspreadsheetUsing activities as part of falls programUsing activities as part of falls programInvolving all staff in decision makingInvolving all staff in decision makingAssessing residents for pain using a pain rating scaleAssessing residents for pain using a pain rating scaleDetermining the expectations of the resident’s family Determining the expectations of the resident’s family prior to admissionprior to admissionIdentifying potential safety hazards by testing various Identifying potential safety hazards by testing various room layoutsroom layouts

Falls Prevention Falls Prevention Performance Improvement Project Performance Improvement Project

Additional SolutionsAdditional Solutions

Adapt the resident’s environment to eliminate safety Adapt the resident’s environment to eliminate safety hazardshazards

Assess hems of clothing and bedspreadsAssess hems of clothing and bedspreads

Use of non-slip type coasters under bed wheelsUse of non-slip type coasters under bed wheels

Develop a “No pedal/No push” policyDevelop a “No pedal/No push” policy

Complete an assessment of need for foot pedalsComplete an assessment of need for foot pedals

Apply bedside mats to wall with Velcro when not in useApply bedside mats to wall with Velcro when not in use

Apply front anti-tippers to wheelchairsApply front anti-tippers to wheelchairs

Apply tape on wall to mark correct bed heightApply tape on wall to mark correct bed height

Falls Prevention Falls Prevention Performance Improvement ProjectPerformance Improvement Project

MonitoringMonitoring

72 Hours72 Hours

Initial High RiskInitial High Risk

15 Minute, One-On-One, Family15 Minute, One-On-One, Family

Preventative MaintenancePreventative Maintenance

Designated Staff Designated Staff

New Way of ThinkingNew Way of Thinking

Falls Prevention Falls Prevention Performance Improvement Project Universal Performance Improvement Project Universal

Safety ConsiderationsSafety Considerations

Consider inside and outside environmentConsider inside and outside environmentUse non-skid floor waxUse non-skid floor waxEnsure thresholds are no higher than ½ inch and beveledEnsure thresholds are no higher than ½ inch and beveledPaint uneven surfacesPaint uneven surfacesEnsure adequate room lightingEnsure adequate room lightingEnsure loose carpet, tiles or linoleum are repairedEnsure loose carpet, tiles or linoleum are repairedInstall bathroom safety equipmentInstall bathroom safety equipmentEnsure appropriate bed height, chair and toilet heightEnsure appropriate bed height, chair and toilet heightClean up spills immediatelyClean up spills immediatelyReduce non-emergency pagingReduce non-emergency pagingCreate and maintain a clear path to the bathroomCreate and maintain a clear path to the bathroom

Other Falls Management Program Other Falls Management Program Considerations Considerations

Identify all products used by your facility to Identify all products used by your facility to manage fallsmanage fallsIncorporate pictures and names of your products Incorporate pictures and names of your products in your new hire orientationin your new hire orientationEnsure manufacturers’ instructions for devices Ensure manufacturers’ instructions for devices and equipment are available and followedand equipment are available and followedDevelop parameters to guide the appropriate Develop parameters to guide the appropriate use of products used by your facility to manage use of products used by your facility to manage fallsfallsDesignate a staff member to do the initial fall Designate a staff member to do the initial fall assessment upon admissionassessment upon admission

Other Falls Management Program Other Falls Management Program Considerations (Continued)Considerations (Continued)

Consider reviewing all falls every day at your Consider reviewing all falls every day at your stand up meeting and observe the scene of the stand up meeting and observe the scene of the fallfallConsider a weekly fall meeting with an Consider a weekly fall meeting with an interdisciplinary teaminterdisciplinary teamIdentify frequent fallers for staffIdentify frequent fallers for staffConsider implementing universal environmental Consider implementing universal environmental fall precautions facility-widefall precautions facility-wideConsider development of a preventive Consider development of a preventive maintenance program for consistent maintenance program for consistent environmental fall risk observationenvironmental fall risk observationConsider developing a method to ensure Consider developing a method to ensure effectiveness of your programeffectiveness of your program

Fall Trivia QuestionsFall Trivia Questions

If you find a resident lying on the floor, is it considered If you find a resident lying on the floor, is it considered a fall?a fall?What is the execution gap?What is the execution gap?Who should be on the falls management team?Who should be on the falls management team?Who would you interview after a fall?Who would you interview after a fall?Name an intervention new to you.Name an intervention new to you.If you take a newly confused resident to the bathroom If you take a newly confused resident to the bathroom what would you do?what would you do?Are all interventions appropriate for all residents?Are all interventions appropriate for all residents?Why would you need to try a new intervention for a Why would you need to try a new intervention for a resident?resident?What would you do if you think you have already tried What would you do if you think you have already tried everything you can think of to prevent another fall?everything you can think of to prevent another fall?

By working together, By working together, you can do this!you can do this!

BibliographyBibliography

Slide 5 - Falls and Fall Prevention in Nursing Homes, Alabama Quality Assurance Slide 5 - Falls and Fall Prevention in Nursing Homes, Alabama Quality Assurance Foundation, August 6, 2001Foundation, August 6, 2001

Slide 5 - We Care. Notes for Slide presentation, AMDA Clinical Practice Guidelines Slide 5 - We Care. Notes for Slide presentation, AMDA Clinical Practice Guidelines (CPCs) for Falls and Osteoporosis, Slide #3(CPCs) for Falls and Osteoporosis, Slide #3

Slide 5 - Scott, RN, Vicky et al, A review of the Literature on Best Practice in Falls Slide 5 - Scott, RN, Vicky et al, A review of the Literature on Best Practice in Falls prevention for Residents of Long Term Care Facilities, September 2003 prevention for Residents of Long Term Care Facilities, September 2003

Slide 6 - Hart-Hughes, Stephanie et al, Slide 6 - Hart-Hughes, Stephanie et al, An Interdisciplinary Approach to Reducing An Interdisciplinary Approach to Reducing Fall Risks and Falls, Fall Risks and Falls, Journal of Rehabilitation, 2004, Volume 70, No. 4, 46-51Journal of Rehabilitation, 2004, Volume 70, No. 4, 46-51

Slide 12 - Annals of Internal Medicine – Fall in the Nursing Home – Rubenstein et al. 121 Slide 12 - Annals of Internal Medicine – Fall in the Nursing Home – Rubenstein et al. 121 (6):442.(6):442.

Slide 12 - Premier 2006, Inc – Fall Prevention Slide 12 - Premier 2006, Inc – Fall Prevention (http://www.premierinc.com/all/safety/resources/falls/)(http://www.premierinc.com/all/safety/resources/falls/)