Improving Patient Safety in Long-Term Care Facilities:

Falls Prevention and Management

Student Version

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Introduction

• Falls Prevention: The role of the team in preventing falls

• Falls Management: The role of the team in responding to a fall

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Definition of a Fall

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Facts About Falls in LTC Facilities

• Preventing falls is a serious challenge.• Three of every four residents fall each year.• Most facilities have >100 falls per year.• There are several interventions that help reduce

the number of falls.• Staff must have adequate training to acquire the

knowledge and skills necessary to prevent and manage falls.

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Risk Factors And Prevention Strategies For Falls

• Resident-centered • Environmental► Facility-based

► Organizational

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Patient-Centered Risk Factors

• Previous falls• Fear of falling• Diminished strength• Gait/balance impairments• Vision impairment• Alzheimer’s disease/dementia• Medications

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Focus on: MedicationsAny drug that causes the following increases the risk of falling. DrowsinessDizzinessHypotensionParkinsonian effectsAtaxia/gait disturbanceVision disturbance

Drugs known to increase the risk of fallsSedativesHypnoticsAntidepressants Benzodiazepines

DiureticsAntihypertensive drugsVasodilators

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Case #1: Mrs. Lawson

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Case #1: Mrs. Lawson

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Case #1: Mrs. Lawson

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Case #1: Discussion

• Questions: ► Given Mrs. Lawson’s history, diagnoses and

medications, what is her risk for experiencing a fall?► What steps can staff take to reduce the risk and

incidence of falls for Mrs. Lawson?

• Important to note:► The patient’s history of falls and the medications she

receives puts her at increased risk for falling.► Review the patient’s current medications.► Assess BP frequently.

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Medication Management and Reduction Programs

• Unless prescribed, avoid administering meds at meal times.

• Determine a time during the day to give once daily medications.

• Reduce TID meds to BID whenever possible.• Adjust the timing of BID meds to times that work best for

the individual resident’s schedule.• Discontinue unnecessary medications. • Reduce the number of PRN medications.• Discontinue waking residents for medication whenever

possible.

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Facility-Based Risk Factors

• Overcrowded rooms• Obstacles• Design issues• Equipment misuse or malfunction

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Organizational Risk Factors

• Inadequate staffing• Poor communication• Inadequate staff training• Inadequate QI policy for

falls prevention• Use of restraints

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Falls Assessment

Instruments

• Hendrich II Fall Risk Model• Comprehensive Falls Risk

Screening Instrument• Falls Assessment portion

of The Falls Management Program

• Vanderbilt Fall Prevention Program for Long-Term Care

• Timed Up and Go Test

Common Assessment Elements

• History of falls• Cognition• Impulsivity• Vision• Attached equipment• Ambulation• Continence• High-risk medications• Assistive devices• Familiarity with environment

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HEAR ME

Hazards — notice and eliminate environmental hazards

Education — educate residents about safety

Anticipate — anticipate the needs of residents

Round — round frequently to learn residents’ needs

Materials — ensure materials and equipment are in working order

Exercises — assist residents with exercise and ambulation

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Case #2: Mr. Phillips

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Case #2Mr. Phillips

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Case #2Mr. Phillips

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Case #2: Discussion

• Questions:► What patient-related factors make Mr. Phillips prone to

falling?► What environmental factors may have been at play?

• Important to note► The HEAR ME acronym could be used to highlight

necessary changes to the patient’s environment.► Assistive devices should be checked.► Eye glasses should be checked and kept close.► Nighttime staffing should be reviewed.

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Falls Management

1. Responding to a fall

2. Limiting future falls

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Responding to a Fall

1. Observe and evaluate2. Investigate and document3. Implement individualized

care plan4. Develop falls management

program

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Limiting Future Falls

Patient Interventions• Keep frequently needed

items close• Remove hazards• Add safety equipment• Provide additional aid• Provide a balance

exercise program• Evaluate assistive devices• Develop a care plan

Center-wide Interventions• Medication management and

reduction program• Falls management team• Falls surveillance• Multidisciplinary

assessments• Assessment of staffing

needs• Falls prevention and

management training for staff and residents

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Falls Management Team

• Interdisciplinary group• Meet regularly• Analyze risk factors

for falls• Identify intervention(s)• Perform systemic

evaluation • Monitor and

document results

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Role Of The Care Team In Falls Prevention and Management

• Licensed nurses have assessment skills and knowledge about medications that are essential to preventing and managing falls.

• NAs and other front-line staff spend more time with residents, which gives them insight on how to prevent falls in the context of residents daily activities.

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Teamwork

• Communication• Report possible risks

across the care team• Work together to improve

the risk(s)• Take action as a team

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Case #3: Mrs. Pelham

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Case #3Mrs. Pelham

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Case #2Mrs. Pelham

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Case #3: Findings and Management

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Case #3: Discussion

• Ask the following questions:► What role did the Nursing Assistant play in ‘solving’

this case?► How might a breakdown in team communication have

changed the outcome?

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Quality Improvement

• Plan: Identify a problem and design a change to address it.

• Do: Implement a small change.

• Study: Measure and analyze the effects of the change.

• Act: Take action based on the results of analysis, such as trying another change.

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Case #4: Increased Incidence of Falls

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Case #4: Increased Incidence of FallsThe Problem

• Falls have increased by 21% in past year• Team assembled to investigate

► NAs► Licensed staff► Social Worker► Occupational Therapist

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Case #4: Increased Incidence of FallsWhat the Team Learned

• The facts:► Falls typically occur Thursday-Saturday► Between 9 AM and 2 PM► More falls occur more in women than men

• The cause:► Floors deep cleaned Thurs-Sat after breakfast► Hairdresser onsite Thurs-Sat, 9 AM to 2 PM► Hair salon in basement

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Key Points

• Multiple risk factors

• Fall risk assessment

• Risk assessment after a fall

• Fall prevention requires active engagement

• Teamwork necessary to prevent falls

• Go beyond incident report to develop a revised care plan after fall