WoodGreen Community Services

Community Care and Wellness for Seniors

Falls Prevention Strategy/FrameworkIn-home care

Objectives

- To ensure a falls prevention framework that will help our clients (seniors aged 55 and older) live independently, longer and with dignity in their own home.

- Falls prevention framework as part of quality improvement within the Community Care and Wellness for Seniors unit

The FALLS Cycle

Adapted from Public Health Agency, 2005

CCWS Falls Prevention Framework (In-home care)

CCWS Falls Prevention Framework (In-home care)

CCWS’ Plan to Implement Falls Prevention

o Falls Risk Assessment & Intervention plan (See Appendix 1)

o Policy, procedures, guidelines, and forms for Falls Risk Assessment,

Prevention, and Intervention (including roles and responsibilities of each

care provider – most likely PSW’s)

o Staff communication and education about falls risk and falls prevention

(e.g. Personal Support Worker Training)

o Recommendation to include Falls Prevention Champions as part of CCWS

Quality Committee Team to serve as proxy for regular safety checks and

environmental audits, support the investigation of incidents, and lead

‘Falls Prevention Awareness’ month activities

CCWS Falls Prevention Framework (In-home care)

Multifactorial Approach to Preventing Falls - BEEEACH model

•Education, Equipment, Environment, Activity, Clothing and Footwear, and Health

Management modifications/interventions towards behaviour change

•Each category includes: description of category, risk assessment, interventions and

referral options (if applicable)

Scott et al., Canadian Falls Prevention Curriculum

Education

Consistent and regular communication with clients, family and/or caregivers and

staff is essential to reducing falls and injury from falls. Tools to facilitate

communication include: visual identifiers, direct communication with the circle of

care, client engagement in falls prevention intervention strategies.

•CCWS unit educates its home care providers on the following: o Definition of falls

o Falls statistics – frequency, outcomes, and associated costs

o Impact on quality of life

o Risks assessment and associated intervention plan/options

o Risk management and post-fall follow up

•Clients, family and/or caregiver education and supportive linkages/referrals:

o Health promotion and education team activities such as: “Healthy talks” e.g. staying

safe in the home, diabetes education, etc., client information handouts, etc.

Environment

• Most falls occur in and around the home and an assessment of the home environment aims to enhance accessibility, safety, and performance of daily living (Public Health Agency of Canada, Report on seniors’ fall in Canada, 2005).

• CCWS home care providers to assess indoor and outdoor home environment as part of a Falls Risk Factor and Intervention Plan (as shown below)

• A home environment hazard checklist should also be completed for a more comprehensive environment risk assessment and interventions (Appendix 2).

Equipment

• Equipment and Assistive devices may reduce the risk of falls if properly used and maintained.

• If client uses mobility aids or assistive devices, CCWS home care providers to assess based on the Falls Risk Factor and Intervention Plan (as shown below) and intervene accordingly.

• Staff should also use the inter-RAI CHA to assist with identifying clients with physical function limitations related to gait, balance, etc. beyond the improper use of mobility and assisted devices.

Equipment

Improper use of cane, walker, w heelchair or other assisted devices

CCAC Occupational Therapy VHA Rehab Solutions

Revised August 2013

Client Nam e:

Assessed By: Date:

Activity

History & Physical Activity

Previous falls (within one year) Impaired mobility Decreased strength, balance & flexibility Inactivity or reduced physical activity

CCAC Physiotherapy Toronto Public Health Physical Activity Sheet WoodGreen Exercise and Falls Prevention Classes

Revised August 2013

Falls Risk A ssessm ent Tool & In te rven tion P lan

Client Nam e:

Assessed By: Date:

• Inadequate physical activity and age related changes such as: decreased strength, balance, and flexibility present a risk factor for falls.

• CCWS home care providers encourage staff to engage in regular physical activity to reverse age related changes and increase strength, balance, flexibility and endurance. The Falls Risk Factor and Intervention Options below should be used to evaluate falls risk related to physical activity.

• Staff should also refer to the inter-RAI CHA to assist with identifying clients with physical function limitations related to gait, balance, etc.

Clothing and Footwear

Environment

Home Environment Hazards (e.g. loose rugs, poor lighting, clutter, cracked sidewalks)

Yes, please complete Home Environment Hazard Checklist (back of page)

o Home Environment Modifications (e.g. raised toilet seat, grab bars, etc.)

o Refer to Social Work

No

Clothing and Footwear

Foot ulcers / bunions Inappropriate/unsafe footwear Loose fitting clothes

Foot care Clinic/ Nurse Foot Care Info-Sheet Refer to Podiatry or Chiropody Refer to Social Work

Revised August 2013

Falls Risk A ssessm ent Tool & In te rven tion P lan

Client Nam e:

Assessed By: Date:

• Inappropriate, no support and inadequate fit clothing and footwear are key risk factors for falls

• CCWS home care providers to assess based on the Falls Risk Factor and Intervention Plan (as shown below) and intervene or refer clients as needed.

Health Management

Health Management

4 or more medications

Medications for calming / sleeping

Safe Medication Use For Seniors Brochure Sleep Information Package Consult with Family Doctor

Nutritional Deficits Refer to Community Dietician (Eat Right Ontario) Meals on Wheels or Congregate Dining Program Canada Food Guide

Hearing Deficits Canadian Hearing Society Consult with Family Doctor

Vision Deficits Optometrist

Cognitive Deficits Adult Day Program Refer to Social Work

Incontinence Blood pressure fluctuations

Refer to Health Promotion Clinics Limit alcohol, sugar, artificial sweeteners and caffeine

Alcohol (1+ drink per da y) Prevent a Fall Handout

Revised August 2013

Falls Risk Assessm ent Tool & In terven tion P lan

Client Nam e:

Assessed By: Date:

• Medication reviews and medication reconciliation between transitions is an effective way of reducing the side effects of medications and potential falls risk (Pharmacoepidemiology Drug Safety, Medication use and risk of falls, 2002)

• CCWS home care providers to assess based on the Falls Risk Factors and Intervention Plan (as shown below) and intervene or refer clients as needed.

CCWS Falls Prevention Framework (In-home care)

Quality Measurement & Indicators

Falls Indicator Definition and GoalsFalls Rate The total number of falls as a percentage of the total

number of clients within the target population. The goal should be to achieve an annual percentage reduction.

Completed Falls Risk Screening on Admission The total number of clients admitted to service for whom a falls risk screening was performed as a percentage of the total number of clients admitted to service during the identified time period. The goal should be to complete this for 100% of clients.

Falls Risk Assessment Completed Following a Fall (Post-Fall Assessment)

The total number of clients who experienced a fall for whom a falls risk assessment was performed as a percentage of the number of clients who experienced a fall in a defined time period. The goal should be to complete this for 100% of clients.

Falls Risk Assessment Completed Following a Significant Change in Medical Condition

The total number of clients who experienced a significant change in medical status for whom a falls risk assessment was performed as a percentage of the total number of clients who experienced a significant change in medical status in a defined time period. The goal should be to complete this for 100% of clients.

CCWS Falls Prevention Framework (In-home care)

Program Evaluation

• All new staff should be oriented and trained on CCWS falls prevention

framework and tool

• Quality indicators used to track outcomes of falls prevention framework

• Track number/percentage of clients who get who get connected to

service following a fall (post- fall follow up)

• Ongoing staff education and feedback re: Falls Prevention Assessment

and Intervention tools

• Opportunity for quarterly/semi-annual reports based on indicators to be

prepared for CCWS quality committee

Next Steps

• Audit public folders and files to ensure revised Falls Prevention

Assessment Tool is saved and accessible to all staff

• Training on revised CCWS Falls Prevention Assessment Tool to be

completed in Q4 (January – March, 2013)

• Falls Prevention Intervention Resource Package documents to be stored

at a central location for ease of access

• Operational processes to support tracking and reporting of quality

indicators to be developed

• Falls prevention quarterly/semi-annual reports to CCWS quality

committee

Appendix 1

Risk Factor Intervention & Referral Options History & Physical Activity

Previous falls (within one year) Impaired mobility Decreased strength, balance & flexibility Inactivity or reduced physical activity

CCAC Physiotherapy Toronto Public Health Physical Activity Sheet WoodGreen Exercise and Falls Prevention Classes

Equipment

Improper use of cane, walker, wheelchair or other assisted devices

CCAC Occupational Therapy

VHA Rehab Solutions

Environment

Home Environment Hazards (e.g. loose rugs, poor lighting, clutter, cracked sidewalks)

Yes, please complete Home Environment Hazard Checklist (back of page)

o Home Environment Modifications (e.g. raised toilet seat, grab bars, etc.)

o Refer to Social Work

No

Clothing and Footwear

Foot ulcers / bunions Inappropriate/unsafe footwear Loose fitting clothes

Foot care Clinic/ Nurse Foot Care Info-Sheet

Refer to Podiatry or Chiropody Refer to Social Work

Health Management

4 or more medications

Medications for calming / sleeping

Safe Medication Use For Seniors Brochure Sleep Information Package Consult with Family Doctor

Nutritional Deficits Refer to Community Dietician (Eat Right Ontario) Meals on Wheels or Congregate Dining Program Canada Food Guide

Hearing Deficits Canadian Hearing Society Consult with Family Doctor

Vision Deficits Optometrist

Cognitive Deficits Adult Day Program Refer to Social Work

Incontinence Blood pressure fluctuations

Refer to Health Promotion Clinics Limit alcohol, sugar, artificial sweeteners and caffeine

Alcohol (1+ drink per da y) Prevent a Fall Handout Revised August 2013

Falls Risk A ssessm ent Tool & In te rven tion P lan

Client Nam e:

Assessed By: Date:

Appendix 2 – Home Environment Hazards Checklist