h-10 falls prevention and management

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Section: Risk Management Policy/Procedure: Falls Prevention andManagement Program

By Authority of the LTC Committee:Director of LTC Services

Effective Date: June 30, 2011Revised: August 22, 2011

POLICY

The homes shall ensure that a falls interdisciplinary prevention and managementprogram will be maintained to reduce the incidence of falls and the risk of injury to theresident and promote resident independence.

PURPOSE

The purpose of the Falls Prevention and Management Program at Hastings/QuinteLong Term Care Services is to develop, implement, monitor and evaluate an

interdisciplinary team falls prevention approach and management strategies that fosterresident independence and quality of life while ensuring safety for the resident and otherresidents and staff.

The program focuses on reducing the incidence of residents falls and mitigating risks offalls through a resident focused, team approach which ensures that a residentsenvironment and social, physical, cognitive and emotional strengths are supported. Theprogram ensures team training, communication and effective care planning.

PROGRAM GOALS

To improve and maintain a residents optimal functional level and quality of life. To identify and reduce or eliminate environmental risk factors for residents. To identify and reduce or eliminate health risk factors for residents. To reduce the frequency of falls. To reduce the severity of injuries from falls. To ensure best practice interventions for residents who have fallen. To monitor and track trends related to resident falls. To educate residents and families on their role in falls prevention and

management.

DEFINITIONS

A fall is any unintentional change in position where the resident ends up on the floor,ground or other lower level ( Resident Assessment Instrument (RAI) RAI-MDS 2.0 Users Manual , Canadian Institute for Health Information, September 2010).

Includes witnessed and un-witnessed falls Includes if resident falls onto a mattress placed on the floor Includes whether there is an injury or not.


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A near fall/near miss is a sudden loss of balance that does not result in a fall or otherinjury. This can include a person who slips or trips that does not result in a fall or otherinjury. This can include a person who slips, stumbles or trips but is able to regain controlprior to falling.

An un-witnessed fall occurs when a resident is found on the floor and neither theresident nor anyone else knows how he or she got there.

Serious Injury includes: fractures, laceration-requiring sutures, and any injury requiringassessment in Emergency or admission to the hospital.

RESPONSIBILITY

All Nursing Staff

FORMS

Falls Prevention and Management Decision Tree Appendix A Fall Risk Assessment in PointClickCare Appendix B Fall Prevention Focus in the Care Plan Library of PointClickCare Appendix C Post Fall Screen for Resident/Environmental Factors, Nursing Form #094 -Appendix D Sample Data Collection Appendix E If The Shoe Fits Handout Handout in Admission Package Appendix F Assisting a Falling Resident - Appendix G Falling Star Program Appendix H Transfer Information Centre Appendix I

PROCEDURE

An interdisciplinary team approach to roles and activities for fall risk assessment andstrategies for prevention of falls using the Falls Prevention and Management DecisionTree .


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A: Fall Prevention

Registered Nursing Staff:1. Collaborate with resident/substitute decision-maker (SDM) and family and

interdisciplinary team to conduct the fall risk assessment (e.g. RAI-MDS 2.0) within 24 hours of admission (e.g. using RAI-MDS 2.0) quarterly (according to the RAI-MDS 2.0 schedule) when a change in health status puts them at increased risk for falling such as:

o 2 falls in 72 hourso more than 3 falls in 3 monthso more than 5 falls in 6 monthso significant change in health statuso falls resulting in serious injury

2. Complete the Fall Risk Assessment in PointClickCare to determine the residentslevel of risk as Low or High. Any risk should be care planned and treated.

3. Initiate a written plan of care within 24 hours of admission based on residentsassessed condition, fall history, needs, behaviours, medications and preferencesusing the Fall Prevention Focus in the Care Plan Library in PointClickCare.

4. Continue to update the care plan based on the RAI- MDS 2.0 assessment andcomplete the care plan within 7 days after admission.

5. Refer the resident to the interdisciplinary team as deemed appropriate andinitiate strategies/activities to reduce/minimize the risk of falls (e.g. to

Physiotherapy, Pharmacy, Activity programs based on individual preferences).6. Assess for and implement nursing restorative/rehabilitation activities as part ofRAI-MDS 2.0 care planning and communicate interventions to appropriate staff.

7. Monitor and evaluate the care plan at least quarterly in collaboration with theinterdisciplinary team. If the interventions have not been effective in reducingfalls, initiate alternative approaches and update as necessary.

8. Communicate to the team, the resident/Power of Attorney (POA)/SubstituteDecision Maker (SDM) as needed changes to the care plan regarding fallsprevention and/or risk mitigation/management on an ongoing basis and annuallyat the care conference.

9. Request that Resident/Family/POA/SDM assist in ensuring that the resident has

proper footwear as per their admission package.10. Request that Resident/Family/POA/SDM assist in ensuring that the resident hasproper eye glasses/hearing aid and other assistive devices or are purchased andin good working order.

11. Ensure Resident Safety Information Centre is up to date and accurate.


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Health Care Aides (HCAs)/Personal Support Workers (PSW):1. Follow the interventions as outlined on the care plan.2. Assist and report any resident who appears unsteady.3. Promote adequate fluid intake to avoid dehydration and confusion.4. Report if the resident is having or demonstrating behaviours that indicate pain.5. Remember that a resident with a Urinary Tract Infection may need more frequent

help to the bathroom.6. Follow the Resident Safety Information Centre located above each residents

bed.7. Provide input on appropriate alternatives that could be trialled to assist the

resident in fall prevention.

8. Assisting a falling resident (see attached).Physiotherapist (on referral):

1. Review results of RAI- MDS 2.0 assessment as appropriate.2. Assess residents identified as being at risk for falls using formal assessment

tools such as: Functional Reach Test Timed Up and Go Test Timed Chair Stand (30 sec) Test Rapid Step Test (2 minutes) Tinneti Scale or Berg Balance Scale

3. Implement strategies based on the assessment findings (e.g.Gait/balance/transfer training).4. Share strategies that can be used by the interdisciplinary team to promote

resident independence and safety.5. Recommend equipment, supplies, devices and assistive aids to prevent falls; and6. Recommend care plan strategies for nursing restorative/rehabilitation

interventions.

Physician/Pharmacist (via the Falling Star Program or as referred):1. Conduct a medication review.2. Consider bone supplement.

3. Refer to specialists if required

Activation/Recreation Staff:1. Assess leisure and recreational interests and activity patterns and pursuits.2. Engage the resident in activities that are meaningful to the resident ensuring the

level of activity is safe and the equipment and level of supervision meet theresidents individual needs and wishes.


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3. Contribute to nursing restorative/rehabilitation activities identified on the careplan in collaboration with nursing.

Care Plan Rounds/RHA Meetings:1. Communicate regarding their roles and responsibilities in falls prevention as

outlined on the residents care plan2. Monitor, evaluate and document resident progress and outcomes.

B. Fall and Post Fall Assessment and Management

When a resident has fallen, the resident will be assessed regarding the nature of the falland associated consequences, the cause of the fall and the post fall care managementneeds.

Person witnessing the fall or finding the resident after the fall:1. Assess the environment, before mobilizing the resident, for clues as to objects

which may have struck the resident during the fall or caused the fall.2. Do not move the resident if there is suspicion or evidence of injury until a full

head to toe assessment has been conducted and appropriate action determined.(e.g. transfer to hospital).

3. Notify the registered nursing staff.

4. PSW/HCA to complete the Post Fall Screen for Resident/Environmental Factors(Appendix A).

Registered Nursing Staff:1. Complete the head to toe assessment2. Move the resident, ensuring that the proper lifting procedures are performed (2

person lift if the resident is able to weight-bear, otherwise a 2 person lift using amechanical lift).

3. Observe for pain or difficulty weight bearing if no injury is evident.4. Notify the attending physician, POA/ SDM of the fall, interventions and status of

the resident.5. Initiate Head Injury Routine (HIR) for all unwitnessed falls and witnessed falls

that have resulted in a possible head injury or if the resident is on anticoagulanttherapy.

6. Monitor every hour for the first 4 hours and then every 4 hours for 24 hours postfall for signs of neurological changes (e.g. facial droop, behaviour changes, andweakness on 1 side).

7. Complete a Resident Fall Report on PointClickCare including all contributingfactors.


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8. Document in the progress notes indicating Resident Fall Report has beencompleted and any needed follow up.9. Redo the Fall Risk Assessment and ensure the PSW has completed a Post Fall

Screen for Resident/Environmental Factors form, review the fall preventioninterventions and modify the plan of care in collaboration with the interdisciplinaryteam.

10. Communicate to all shifts that the resident has fallen and share detail regardingthe interventions initiated.

11. Emphasize the details of the fall, interventions and outcomes and stress the needfor ongoing follow-up in subsequent shifts at report.

12. Arrange a care conference for residents who fall frequently as indicated by:

2 falls in 72 hours more than 3 falls in 3 months more than 5 falls in 6 months

Director of Nursing/Delegate1. Complete the on-line MOHLTC Critical Incident Report if the fall resulted in the

resident being transferred to the hospital or admitted to the hospital.2. Follow the homes Disclosure of Adverse Events Policy and Death Protocols if the

fall has resulted in resident death.3. Compile and analyze fall statistics (see sample).

The interdisciplinary team:1. Conduct an interdisciplinary conference to determine the possible cause of fallsand develop changes to prevent reoccurrence.

Resident Safety Committee:1. Analyze fall statistics on a monthly basis using fall data and RAI-MDS Outcome

Scales.

C. Staff Training and Education

Orientation for Direct Care Staff:

1. Provide orientation and training on the falls prevention and management program(policy, procedures, tools) including the importance of the program and the risk toresidents health due to falls.

2. Registered staff (RNs and RPNs) complete the Registered Nurses Associationof Ontario (RNAO) Falls Prevention Self-Learning Package or equivalent.

3. Falling Star Program (see attached).


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Ongoing Training for Direct Care Staff:1. Review the falls prevention and management program training annually.2. Falling Star Program (see attached).

Resident/Substitute Decision Maker1. The Admission Clerk will review the If The Shoe Fits handout provided in the

Admission Package with the Resident/SDM (see attached). 2. The Director of Nursing/Delegate will provide education to residents at Town Hall

meetings, Nursing Council and Villa meeting regarding fall prevention strategies.


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APPENDIX A FALL PREVENTION AND MANAGEMENT DECISION MAKING TREE


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APPENDIX B - FALL RISK ASSESSMENT IN POINTCLICKCARE


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APPENDIX C - FALL PREVENTION FOCUS IN THE CARE PLAN LIBRARY OFPOINTCLICKCARE


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APPENDIX D POST FALL SCREEN FOR RESIDENT/ENVIRONMENTALFACTORS

NOTE: This is a sample of the first page of the form. Do not copy this page.


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APPENDIX E - SAMPLE DATA COLLECTION


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APPENDIX F - IF THE SHOE FITS HANDOUT IN ADMISSION PACKAGE


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APPENDIX G ASSISTING A FALLING RESIDENT


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APPENDIX H FALLING STAR PROGRAM


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APPENDIX I TRANSFORMATION INFORMATION CENTRE


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NOTE: This is a sample of the first page of the form. Do not copy this page.

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