Bahan Pembelajaran Manajemen pasien safety

Falls Prevention

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}

IMPACT

 _{30-40% of people over age 65 will have a}

fall each year

 _{In an elderly patient who has fallen, the risk}

of having a second fall within a year rises to 60%

Consequences



5-10% of community dwelling elderly

who fall will suffer a serious injury

 _{Up to 20-30% of elderly patients overall}



Falls increase risk of going to nursing

facility

 _{3 fold increase for falls without injury}

 _{10 fold increase for falls with serious injury}

 _{8% of people > 70 come to ER for falls}

each year

 _{1/3 will be admitted}

Rubenstein LZ, Josephson KR. Falls and Their Prevention in the Elderly. Med Clin N Amer 2006;90:807-824

Injuries

 _Fractures

 _{1% of falls in the}

elderly lead to hip fx

 _{20-30% mortality in} the year after hip fx

 _{¼ to ¾ of patients} do not recover prior level of ADLs

Injuries



Other Fractures

 Humerus

 _Rib



Subdural Hematoma



Prolonged lie-

_{half of all elderly}

patients who fall are unable to get back up

 ₂o rhabdo, dehydration/ARF, pressure injury

Post Fall Anxiety Syndrome

“Fallophobia”

 _{Picture the geriatric fall as} a node on a decline spiral

Self-limiting activity, worsening deconditioning, social isolation

Falls are a Prototypical Geriatric

Syndrome

Multifactoral Risk Factor

Risk Factor Odds Odds

Ratio

Ratio

Lower extremity weakness

Lower extremity weakness 4.44.4 History of falls

History of falls 3.03.0 Gait deficit

Gait deficit 2.92.9

Balance deficit

Balance deficit 2.92.9 Need for assistive device

Need for assistive device 2.62.6 Visual defect

Visual defect 2.52.5

Arthritis

Arthritis 2.42.4

Impaired activities of daily living

Impaired activities of daily living 2.32.3 Depression

Depression 2.22.2

Cognitive impairment

Cognitive impairment 1.81.8 Age > 80 years

Age > 80 years 1.71.7

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}

Incidence of falls



What?



Who?



When?



Where?

Outcomes of falls

 _{psychological effects (fear of falling)}  _{decreased level of functioning and}

independence

 _injuries  _mortality

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}

Risk factors:

Physical

_age

_{history of falls} _illness

_{neurologic disease}

_{mobility or balance impairment} _{postural hypotension}

_{sensory impairments} _incontinency

Risk Factors



Cognitive



Pharmacological

_{(benzodiazepine/sedatives,}

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

Falls Screening

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

What happens after a fall

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,}

Interventions:

Cognition

_{Increase light at twilight}

_{Provide meaningful activity}

_{Follow “Least Restraints Guidelines”}

_{Encourage family members/friends/sitters to}

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 pumping in}

sitting position before walking

_{Encourage patient to sit down immediately if}

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

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}

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

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}

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,}

Interventions:

Meds

_{Review medication list for drugs which may}

predispose patient to falls

Community Resources

_{Day Hospital} _{Falls Programs} _CCAC

_{Day Programs}

_{Emergency Response Systems} _MOW

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