falls prevention

Falls Prevention

Shawna Cassidy, Physiotherapist

Shoshana Berliner, Occupational Therapist

North York General HospitalMarch 2006

Fall prevention

Definition of a fall: A fall is considered “an event that results in a

person coming to rest inadvertently on the ground or floor or other lower level.” (Registered Nurses Association of Ontario, 2002)

According to the Institute for Healthcare Improvements, a fall also includes “patients assisted to the floor”.

Overview

Definition of a fall Importance of fall prevention (incidence and

outcomes)Fall risk factorsOverview and goals of Falls ProgramWhat is involved in the Falls ProgramAssessment of fallsFalls interventionsProgram Outcomes

Incidence of falls

What?Who?When?Where?Why?

Outcomes of falls

psychological effects (fear of falling) decreased level of functioning and

independence injuries mortality delayed discharges

Case Study

Risk factors: Environmental

poor lightingfloor surfacesunsteady furnituretelephone, call bells

not in easy reachheight of seatingcluttered pathways

ill-fitting clothing, diapers

non-working hearing aids

dirty or improper eyeglasses

inappropriate footwear

Risk factors: Physical

agehistory of fallsillnessneurologic diseasemobility or balance impairmentpostural hypotensionsensory impairmentsincontinencypoor nutrition

Risk Factors

CognitivePharmacological

(benzodiazepine/sedatives, polypharmacy >5 meds)

Overview of Falls Prevention Program

Need for programPatient safetyMultidisciplinary approach

Program will only work if everyone helps out!

Goals of program

Identification of patients at risk to fall Implementation of preventative measures to

decrease falls Examination of circumstances surrounding a fall Educational program for staff Increase in patient and family participation and

awareness of falls and fall prevention Monitoring of incidence, time and location of

falls, severity of injury and overall effectiveness of the program

Procedure

Flow chart

Falls Screening

SPPICES

Assessment

SPLATT (Falls History)S - symptoms at time of fall(s)P - previous number of falls or near fallsL - location of fall(s)A - activity at time of fall(s)T - time of fall(s) and time on groundT - trauma or injury with fall(s) [physical,

emotional]

What happens after a fall

Incident Report

Interventions: Cognition

Simplify tasksAvoid changes or make changes

graduallyRemove excessive stimulationUse clear, concise communicationProvide consistency in staff and routineProvide orientation cues (calendars,

clocks)

Interventions: Cognition

Increase light at twilightProvide meaningful activityFollow “Least Restraints Guidelines”Encourage family members/friends/sitters to

remain with patient

Interventions: Physical Status

Place hearing/visual aids close byEncourage toiletting routine (q2hrs)Provide bedside commodeEnsure urinal is within reachReduce fluid intake after dinnerEnsure patient maintains adequate nutritionEncourage patient to dangle before

standing/walkingEncourage patient to perform ankle pumping in

sitting position before walkingEncourage patient to sit down immediately if

feeling dizzy

Interventions: Mobility/Gait

Make sure patient uses proper gait aid

Place gait aids at side of bed (canes at bottom of bed)

Ensure gait aids are at appropriate height

Provide visual cues/signs to remind patient of safety techniques for transfers, ambulation

Interventions: Mobility/Gait

Ensure patients wear shoes/non-skid socks at all times

Provide patient and/or family with Falls Prevention Pamphlet

ROM exercises, prevention of deconditioning

Review fall prevention techniques with patient and/or family

Interventions: Environmental

Ensure height of bed/chair is at level where the patient’s feet touch the floor

Keep bottom bedrails downEnsure easy access to call bell,

radio/tv controlsEnsure improved lighting, minimize

glareMaintain straight paths to bathroom

Interventions: Environmental

Use bedside commodes for patients who can transfer independently but are unsafe to ambulate independently to bathroom

Ensure clean, dry floorsPlace higher risk patients in room near nurse's

stationPlace higher risk patients in bed by

bathroomEnsure brakes on equipment are

operational

Interventions: Environmental

Encourage use of appropriate footwear and properly fitting clothing

Place garbage under sink and no basins on bathroom floor

Remove equipment not in usePlace IV equipment at top of bedEnsure nightlights are operational and in usePush bed against wall; place mattress on

floor, beside bed, if patient climbing out of bed

Interventions: Meds

Review medication list for drugs which may predispose patient to falls

Decrease use of benzodiazepinesDiuretics given in the morning

Community Resources

Day HospitalFalls ProgramsCCACDay ProgramsEmergency Response SystemsMOWAssistive Devices ProgramWheel Trans

Outcomes of Program

Staff, patients, families educated on fall prevention

Increased awareness of need for teamwork to keep patients safe

Decrease number of falls and injuries secondary to falls