new approaches in the acute care, skilled nursing, and
TRANSCRIPT
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New Approaches in the Acute Care, Skilled Nursing, and Home Health Care
Settings for Geriatric RehabilitationEvidence-Based Tests and Treatment for Optimal Outcomes,
Compliance, and Reimbursement
Denise Kean, OTR/L, is the President of Rehab Activities & Services, Inc. and is a licensed occupational therapist with over 34 years experience of geriatric clinical practice in Oregon. The scope of her practice covered all the facets and settings of geriatric care including: skilled nursing, home health, comprehensive rehab, acute care and outpatient.
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Centers for Disease Control and Prevention National Center for Injury Prevention and Control
Algorithm for Fall Risk Assessment & InterventionsLow
RiskM
oderate RiskH
igh Risk
Conduct multifactorial risk assessment
• Review Stay Independent brochure
• Falls history• Physical exam including:
- Postural dizziness/ postural hypotension
- Medication review- Cognitive screen- Feet & footwear- Use of mobility aids- Visual acuity check
HIGH RISK Individualized fall
interventions• Educate patient• Vitamin D +/- calcium• Refer to PT to enhance
functional mobility & improve strength & balance
• Manage & monitor hypotension
• Modify medications• Address foot problems• Optimize vision• Optimize home safety
Follow up with HIGH RISK patient within 30 days
• Review care plan
• Assess & encourage fall risk reduction behaviors
• Discuss & address barriers to adherence
————Transition to maintenance exercise program when patient is ready
Patient completes Stay Independent brochure
Gait, strength or balance problem
YES to any key question
Screen for falls and/or fall riskPatient answers YES to any key question:
• Fell in past year? If YES ask, - How many times? and,- Were you injured?
• Feels unsteady when standing or walking?• Worries about falling?
Injury No injury
1 fall 0 falls
MODERATE RISK Individualized fall
interventions• Educate patient • Review & modify medications• Vitamin D +/- calcium• Refer to PT to improve gait,
strength & balance or
refer to a community fall prevention program
LOW RISK Individualized fall
interventions• Educate patient• Vitamin D +/- calcium• Refer for strength & balance
exercise (community exercise or fall prevention program)
NO to all key
questions
No gait, strength
or balance problems*
≥ 2 falls
Evaluate gait, strength & balance• Timed Up & Go (recommended)• 30 Second Chair Stand (optional)• 4 Stage Balance Test (optional)
*For these patients, consider additional risk assessment (e.g., medication review, cognitive screen, syncope)
Any opinions, findings, recommendations or conclusions expressed by the author(s) or speaker(s) do not necessarily reflect the views of Summit Professional Education. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.
© Copyright 2016 Denise Kean, OTR/L & Summit Professional Education. No part of this workbook may be reproduced in any manner without the expressed written consent of Denise Kean, OTR/L and Summit Professional Education.
From a Declaration of Principles jointly adopted by a committee of the American Bar Association and a committee of Publishers.
Workshop Manual ID:
2220