Falls Reduction Training Program

Falls Reduction Training Program

[Insert facility name here.] Falls Prevention Program Used with permission Learning Objectives Identify the impact of falls on patients and the organization Recall federal regulations and accrediting standards for falls prevention Identify intrinsic and extrinsic factors for falls Recognize the role of patient assessment in falls prevention efforts Identify strategies to prevent patient falls 2

2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Falls Facts One in three U.S. adults age 65 or older falls each year 10% of older adult falls occur in healthcare institutions 2% to 10% of hospital inpatients fall during a hospital stay 3 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000

Risk to Patient 30% of inpatient falls result in injury Most common serious injury sustained from a fall is hip fracture An estimated one in five individuals who sustain a hip fracture die within a year of the injury. Other potential complications include loss of confidence in mobility, reduced activity resulting in muscle weakening, and increased risk for falling again. 4 2012 ECRI Institute.

Educational materials from ECRI Institute, (610) 825-6000 Risk to Facility Fall injury treatment costs Extended hospital stays Insurance claims Lawsuits 5 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000

Joint Commission Standards Joint Commission accreditation standards require facilities to: Assess the patients risk for falls Implement interventions to reduce falls based on the patients assessed risk Evaluate the effectiveness of all falls reduction activities 6 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 CMS Requirements

The Centers for Medicare and Medicaid Services (CMS) requires facilities to provide care within a safe setting. 7 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 CMS Rule on Hospital-Acquired Conditions Hospital-acquired conditions are those considered by CMS to be reasonably preventable with the implementation of evidencebased guidelines. Effective October 2008, CMS no longer reimburses hospitals to treat injuries from falls sustained in the hospital if the fall could have been prevented during the Medicare beneficiarys stay.

8 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Defining Fall, Fall with Harm, and Near Fall Definitions are needed for consistent collection and comparison of data. Provides staff guidance for reporting Allows comparison to internal and external benchmarks Fall[insert facility definition of fall] Fall with harm[insert facility definition of fall with harm]

Near fall[insert definition of near fall] 9 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Current Falls Rate and Goal [Insert data for facilitys current falls rates by unit, time of day, injury severity, etc., if available] [Insert facilitys target falls rates] 10 2012 ECRI Institute.

Educational materials from ECRI Institute, (610) 825-6000 Why Do People Fall? Multiple factors combine to create risk for falling. Intrinsic factors are related to the patients physical, mental, and cognitive condition. Extrinsic factors are related to the patients environment. 11 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000

Intrinsic Factors Age greater than 65 History of falls Incontinence or urinary frequency or urgency Lower-extremity weakness Gait and balance deficits Use of tranquilizers, sedative-hypnotic drugs, or antihypertensive drugs Use of four or more prescription drugs Postural or orthostatic hypotension Reduced visual acuity Slow darkness adaptation Loss of hearing

12 Educational materials from ECRI Institute, (610) 8256000

Perceptual changes Neuropathy Proprioceptive dysfunction Degenerative disorders of the spine Functional impairment (e.g., inability to perform basic activities of daily living) Changes in mental status, including delirium, dementia, or depression Sundown syndrome Foot disorders Poor impulse control Belief that asking for help is inappropriate Extrinsic Factors Poorly designed bathrooms that do not

include handrails or raised toilets Furniture such as tables, beds, and chairs that are on wheels Flooring that is highly polished, wet, or covered with loose carpeting or rugs Ill-fitting or inappropriate shoes; long or loose clothing Poorly maintained assistive devices (e.g., wheelchairs, support poles, trapezes) Poor instruction on use of assistive devices Time of day (increased risk during shift changes) 13

Educational materials from ECRI Institute, (610) 8256000 Prolonged length of stay Bed in high position

Toilet in low position Use of restraints Full-length bedrails Monochromatic color schemes or distracting colors Distracting noises Poor communication between staff, patient, and family Poor staff training and education Attachment to equipment such as heart monitors or intravenous lines Results of Root Cause Analyses: Factors That Are Causing Falls [Insert facility data describing results of root cause analyses on

falls including most frequent intrinsic and extrinsic factors, if available] 14 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 What Can We Do to Prevent Falls? Multiple interventions are needed:

15 Thorough patient assessment Thorough environmental assessment Medication review Frequent rounding to assist with patients needs, including toileting Reduced use of restraints Proper use of technology to reduce falls risk Effective education of patients and family members 2012 ECRI Institute.

Educational materials from ECRI Institute, (610) 825-6000 Patient Assessment Assessment performed: On admission Routinely during a patients stay to reassess for falls risk When a patients physical condition changes (e.g., after surgery, new medications given) When a fall or near miss occurs When transferred to a new unit As required by state and federal regulation 16

2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Assessment Protocols [Demonstrate facilitys falls assessment tools and protocols] 17 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Environmental Rounds Patient rooms should be evaluated and modified to meet the

patients needs. [Insert section of falls policy outlining staff responsibility to report and address environmental concerns (e.g., wet floors) if applicable] 18 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Environmental Rounds, cont. Ensure that floor-level night-lights do not create shadows and glare. Keep beds in their lowest position. Avoid using full-length bedrails (patients may attempt to climb over

them). Use restraints only when all other interventions have proved to be insufficient. Have patients wear slip-proof socks or appropriate shoes. Ensure that patient clothing (e.g., long gowns) will not cause tripping. 19 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Environmental Rounds, cont. Maintain a quick response time for cleaning up spills, etc. Cordon off wet floors and construction areas. Use caution signs that are understandable to all visitors. Leave dry

areas around wet floors when possible. Appropriately time the mopping or vacuuming of high-volume areas. Ensure that floors do not have glare and are not overwaxed. 20 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Environmental Rounds, cont. Ensure that showers, tubs, and bathroom floors are slip-proof. Make sure furniture wheels (e.g., tables, chairs) are locked. Perform regular preventive maintenance on mobility aids (e.g., canes, walkers, wheelchairs, lifts).

Remove furniture with sharp corners. Ensure that grab bars and wall rails are properly mounted. 21 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Environmental Rounds, cont. Keep floors uncluttered and remove low objects that could cause a patient to trip. Ensure that carpeting does not have bulges. Ensure that steps and grade changes are clearly identified. Minimize distracting noises.

Guard against icy walkways, construction hazards, and uneven surfaces. 22 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Medication Review Administration of these and some over-the-counter medications increases the risk of falling:

23 Educational materials from ECRI Institute, (610) 8256000

Antiarrhythmics Antihypertensives Diuretics Laxatives Neuroleptics Nonsteroidal anti-inflammatory agents Oral hypoglycemics and insulin Psychotropics Sedatives/hypnotics Tricyclic antidepressants Vasodilators Medication Review Risk is greatly magnified if patient is receiving four or more

types of medication [Insert measures pharmacist is taking to inform physician of risk to patient] 24 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Rounding to Assist with Patient Needs Many patient falls occur when the patient does not have the assistance of nursing personnel. Patients may be reluctant to call for assistance. Solution: Routine rounding of patient rooms to check on patient

needs. 25 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 During Visits to Patient Rooms Offer toileting assistance. Ask about pain levels and need for pain medication. Reposition the patient in bed. Ensure necessary items (e.g., tissue, telephone, water, call light, television remote control) are within reach.

26 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Reduced Use of Restraints Use of restraints can lead to physiologic deterioration (e.g., muscle weakness) and psychological effects (e.g., anger). Federal laws require that patients be free from restraints if the restraints are not medically necessary. [Insert facilitys restraint policy highlights] 27

2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Proper Use of Technology to Reduce Falls Fall alarms, such as bed-exit alarms Bedrails and high-low beds Nurse call systems Ambulation and transfer aids 28 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000

Communicating Falls Risks Failure to communicate a patients risk of falling is one of the root causes of falls-related sentinel events. Falls are more likely to occur when staff members have not been apprised of a patients risk of falling. 29 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Communicating Falls Risks, cont. High-risk patients must be clearly identifiable.

Indicators in the medical record Indicators on the patients bed or door or on a whiteboard in the patients room 30 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Communicating Falls Risks, cont. [Insert facilitys method for communicating falls risk during handoffs]

31 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Educating Patients Conduct face-to-face discussions about falls risks that patient can understand. Explain general risk factors. Explain the patients specific risk factors. Explain that the patient should not be afraid to ask for help. Teach the patient how to: Use the call button, assistive devices, mobility aids, etc.

Transfer in and out of bed Avoid falling (e.g., call for assistance), how to fall if unavoidable (e.g., lean against wall) Not to move if he or she falls Document all discussions. 32 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Educating Family Members Explain the patients risk for falling. Provide education on use and maintenance of assistive devices,

mobility aids, etc. Manage family expectations for safety. Express facilitys concern for safety. Explain need to have the patient maintain as high a level of functioning as possible. Document all discussions. 33 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 Training Patients to Use Medical Devices and

Aids [Insert information regarding usage and maintenance of medical devices and aids offered by facility] 34 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 If a Patient Falls . . . Any staff member who finds a fallen patient should remain with and verbally reassure the patient and call for help An assessment must be made to determine the extent of any injuries

35 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 If a Patient Falls, cont. [Insert facilitys policy for responding to a fallen patient] [Insert facilitys policy for communicating with families when a patient falls] 36 2012 ECRI Institute.

Educational materials from ECRI Institute, (610) 825-6000 Reporting Falls: Documentation Location of fall Date and time of fall Description of fall Names of witnesses Notification of patients family and physician Description of any sustained injuries 37 Educational materials from ECRI Institute, (610) 8256000

Treatment provided to fallen patient Intrinsic and extrinsic factors Staffing levels Equipment in use Medications taken by patient New intervention plan Reporting Falls [Insert facility policy highlights on reporting falls] 38 2012 ECRI Institute.

Educational materials from ECRI Institute, (610) 825-6000 Conducting a Postfall Assessment Behavior or functional changes as a result of fall Factors that may have contributed to the fall Review of underlying illnesses and problems 39 Educational materials from ECRI Institute, (610) 8256000

Review of medications Evaluation of environmental conditions Adjustments to the patients care plan Conducting a Postfall Assessment, cont. [Insert facilitys policy highlights for conducting a postfall assessment, including documentation and communication with the patients family and physician] 40 2012 ECRI Institute. Educational materials from ECRI Institute, (610)

825-6000 [Insert facility name] Falls Team [Insert falls team goals (e.g., tracking effectiveness of interventions, consideration of staff feedback on falls policies)] 41 2012 ECRI Institute. Educational materials from ECRI Institute, (610) 825-6000 [Insert facility name] Falls Team Members 42

Educational materials from ECRI Institute, (610) 825-6000 Questions? 43 Educational materials from ECRI Institute, (610) 825-6000

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