Transcript Importance of fall prevention

Falls Prevention
Shawna Cassidy, Physiotherapist
Shoshana Berliner, Occupational
Therapist
North York General Hospital
March 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 factors
Overview and goals of Falls Program
What is involved in the Falls Program
Assessment of falls
Falls interventions
Program 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 lighting
 floor surfaces
 unsteady furniture
 telephone, call
bells not in easy
reach
 height of seating
 cluttered pathways
 ill-fitting clothing,
diapers
 non-working
hearing aids
 dirty or improper
eyeglasses
 inappropriate
footwear
Risk factors: Physical
age
history of falls
illness
neurologic disease
mobility or balance impairment
postural hypotension
sensory impairments
incontinency
poor nutrition
Risk Factors
 Cognitive
 Pharmacological (benzodiazepine/sedatives,
polypharmacy >5 meds)
Overview of Falls
Prevention Program
 Need for program
 Patient safety
 Multidisciplinary 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 falls
L - location of fall(s)
A - activity at time of fall(s)
T - time of fall(s) and time on ground
T - trauma or injury with fall(s) [physical,
emotional]
What happens after a fall
 Incident Report
Interventions: Cognition
 Simplify tasks
 Avoid changes or make changes gradually
 Remove excessive stimulation
 Use clear, concise communication
 Provide consistency in staff and routine
 Provide orientation cues (calendars, clocks)
Interventions: Cognition
 Increase light at twilight
 Provide meaningful activity
 Follow “Least Restraints Guidelines”
 Encourage family members/friends/sitters to
remain with patient
Interventions: Physical Status
 Place hearing/visual aids close by
 Encourage toiletting routine (q2hrs)
 Provide bedside commode
 Ensure urinal is within reach
 Reduce fluid intake after dinner
 Ensure patient maintains adequate
nutrition
 Encourage patient to dangle before
standing/walking
 Encourage patient to perform ankle
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 down
 Ensure easy access to call bell, radio/tv
controls
 Ensure improved lighting, minimize glare
 Maintain 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 floors
 Place higher risk patients in room near
nurse's station
 Place higher risk patients in bed by
bathroom
 Ensure 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 use
 Place IV equipment at top of bed
 Ensure nightlights are operational and in use
 Push 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 benzodiazepines
Diuretics given in the morning
Community Resources
 Day Hospital
 Falls Programs
 CCAC
 Day Programs
 Emergency Response Systems
 MOW
 Assistive Devices Program
 Wheel 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