improving patient safety in long-term care facilities: falls prevention and management
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Improving Patient Safety in Long-Term Care Facilities: Falls Prevention and Management. Student Version. Introduction. Falls Prevention: The role of the team in preventing falls Falls Management: The role of the team in responding to a fall. Definition of a Fall. - PowerPoint PPT PresentationTRANSCRIPT
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Improving Patient Safety in Long-Term Care Facilities:
Falls Prevention and Management
Student Version
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Introduction
• Falls Prevention: The role of the team in preventing falls
• Falls Management: The role of the team in responding to a fall
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Definition of a Fall
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Facts About Falls in LTC Facilities
• Preventing falls is a serious challenge.• Three of every four residents fall each year.• Most facilities have >100 falls per year.• There are several interventions that help reduce
the number of falls.• Staff must have adequate training to acquire the
knowledge and skills necessary to prevent and manage falls.
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Risk Factors And Prevention Strategies For Falls
• Resident-centered • Environmental► Facility-based
► Organizational
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Patient-Centered Risk Factors
• Previous falls• Fear of falling• Diminished strength• Gait/balance impairments• Vision impairment• Alzheimer’s disease/dementia• Medications
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Focus on: MedicationsAny drug that causes the following increases the risk of falling. DrowsinessDizzinessHypotensionParkinsonian effectsAtaxia/gait disturbanceVision disturbance
Drugs known to increase the risk of fallsSedativesHypnoticsAntidepressants Benzodiazepines
DiureticsAntihypertensive drugsVasodilators
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Case #1: Mrs. Lawson
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Case #1: Mrs. Lawson
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Case #1: Mrs. Lawson
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Case #1: Discussion
• Questions: ► Given Mrs. Lawson’s history, diagnoses and
medications, what is her risk for experiencing a fall?► What steps can staff take to reduce the risk and
incidence of falls for Mrs. Lawson?
• Important to note:► The patient’s history of falls and the medications she
receives puts her at increased risk for falling.► Review the patient’s current medications.► Assess BP frequently.
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Medication Management and Reduction Programs
• Unless prescribed, avoid administering meds at meal times.
• Determine a time during the day to give once daily medications.
• Reduce TID meds to BID whenever possible.• Adjust the timing of BID meds to times that work best for
the individual resident’s schedule.• Discontinue unnecessary medications. • Reduce the number of PRN medications.• Discontinue waking residents for medication whenever
possible.
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Facility-Based Risk Factors
• Overcrowded rooms• Obstacles• Design issues• Equipment misuse or malfunction
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Organizational Risk Factors
• Inadequate staffing• Poor communication• Inadequate staff training• Inadequate QI policy for
falls prevention• Use of restraints
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Falls Assessment
Instruments
• Hendrich II Fall Risk Model• Comprehensive Falls Risk
Screening Instrument• Falls Assessment portion
of The Falls Management Program
• Vanderbilt Fall Prevention Program for Long-Term Care
• Timed Up and Go Test
Common Assessment Elements
• History of falls• Cognition• Impulsivity• Vision• Attached equipment• Ambulation• Continence• High-risk medications• Assistive devices• Familiarity with environment
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HEAR ME
Hazards — notice and eliminate environmental hazards
Education — educate residents about safety
Anticipate — anticipate the needs of residents
Round — round frequently to learn residents’ needs
Materials — ensure materials and equipment are in working order
Exercises — assist residents with exercise and ambulation
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Case #2: Mr. Phillips
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Case #2Mr. Phillips
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Case #2Mr. Phillips
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Case #2: Discussion
• Questions:► What patient-related factors make Mr. Phillips prone to
falling?► What environmental factors may have been at play?
• Important to note► The HEAR ME acronym could be used to highlight
necessary changes to the patient’s environment.► Assistive devices should be checked.► Eye glasses should be checked and kept close.► Nighttime staffing should be reviewed.
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Falls Management
1. Responding to a fall
2. Limiting future falls
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Responding to a Fall
1. Observe and evaluate2. Investigate and document3. Implement individualized
care plan4. Develop falls management
program
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Limiting Future Falls
Patient Interventions• Keep frequently needed
items close• Remove hazards• Add safety equipment• Provide additional aid• Provide a balance
exercise program• Evaluate assistive devices• Develop a care plan
Center-wide Interventions• Medication management and
reduction program• Falls management team• Falls surveillance• Multidisciplinary
assessments• Assessment of staffing
needs• Falls prevention and
management training for staff and residents
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Falls Management Team
• Interdisciplinary group• Meet regularly• Analyze risk factors
for falls• Identify intervention(s)• Perform systemic
evaluation • Monitor and
document results
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Role Of The Care Team In Falls Prevention and Management
• Licensed nurses have assessment skills and knowledge about medications that are essential to preventing and managing falls.
• NAs and other front-line staff spend more time with residents, which gives them insight on how to prevent falls in the context of residents daily activities.
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Teamwork
• Communication• Report possible risks
across the care team• Work together to improve
the risk(s)• Take action as a team
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Case #3: Mrs. Pelham
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Case #3Mrs. Pelham
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Case #2Mrs. Pelham
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Case #3: Findings and Management
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Case #3: Discussion
• Ask the following questions:► What role did the Nursing Assistant play in ‘solving’
this case?► How might a breakdown in team communication have
changed the outcome?
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Quality Improvement
• Plan: Identify a problem and design a change to address it.
• Do: Implement a small change.
• Study: Measure and analyze the effects of the change.
• Act: Take action based on the results of analysis, such as trying another change.
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Case #4: Increased Incidence of Falls
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Case #4: Increased Incidence of FallsThe Problem
• Falls have increased by 21% in past year• Team assembled to investigate
► NAs► Licensed staff► Social Worker► Occupational Therapist
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Case #4: Increased Incidence of FallsWhat the Team Learned
• The facts:► Falls typically occur Thursday-Saturday► Between 9 AM and 2 PM► More falls occur more in women than men
• The cause:► Floors deep cleaned Thurs-Sat after breakfast► Hairdresser onsite Thurs-Sat, 9 AM to 2 PM► Hair salon in basement
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Key Points
• Multiple risk factors
• Fall risk assessment
• Risk assessment after a fall
• Fall prevention requires active engagement
• Teamwork necessary to prevent falls
• Go beyond incident report to develop a revised care plan after fall