1	Preventing Falls The price of this course is $12.00 for 1.1 Contact Hours. You will only be asked to pay for the course if you decide to grade the Post Examination to earn a certificate with Contact Hours (CEUs).
2	Objectives At the completion of this presentation you will be able to: Define a fall. Describe the prevalence of falls. Identify factors that place patients at-risk for falling. State 3 interventions that can help reduce falls. Name essential components of the post-fall assessment. State steps to take if a fall occurs. Please note: The term patient in the presentation refers to patients, clients or residents.
3	Introduction From 1992 to 1995 there were 147 million injury related visits made to Emergency Rooms in the United States. Falls were the leading cause of these injury-related visits.
4	Introduction In the hospital setting, patient falls are the most common reported occurrence. In the nursing home setting more than 50% of residents fall annually. One third of community dwelling elders fall each year.
5	Introduction When a person falls, almost ½ suffer moderate to severe injuries that reduce the their mobility and independence, and increase their risk of premature death.
6	Magnitude of the Problem Hip fractures are among the most serious fall related injury. More than 340,000 hip fractures related to falls occurred in 2000. This number is expected in increase dramatically related to the increasing older adult population.
7	Magnitude of the Problem ½ of older adults who suffer a hip fracture never regain their previous level of functioning. Many of these individuals will be unable to live independently after the injury.
8	Magnitude of the Problem Falls lead to significant personal and financial costs for both patients and facilities. In 1994, the cost of fall related injuries was $20.2 billion, by 2020 the cost is projected to be $32.4 billion.
9	Magnitude of the Problem The Centers for Disease Control, (CDC) recently reported that fall related deaths among older adults is increasing. The Joint Commission on Accreditation of Healthcare Organizations has declared fall reduction as a 2007 National Patient Safety Goal for acute care and long term care settings. Goal 9 - Reduce the risk of patient/resident harm resulting from falls. Goal 9b - Implement a fall reduction program including the evaluation of the effectiveness of the program.
10	What is a Fall? A fall is defined as the failure to maintain an appropriate lying, sitting or standing position, resulting in a person’s abrupt undesired relocation to a lower level. A fall without injury is still a fall.
11	Accidental Falls… Account for 23% of all injury-related emergency room visits. Are the leading cause of death in those over age 65. While accidental falls can not be predicted, many can be prevented. Some causes of accidental falls included: spills, clutter inadequate lighting, throw rugs unstable furniture, equipment failures errors in judgment
12	Predictable Falls The majority of falls are predictable. They happen among patients identified at-risk. Those at-risk include patients who: are of advanced age have previously fallen experience impaired gaits, weakness use walking devices or medical equipment have an impaired mental status
13	Unanticipated Falls Some falls are not anticipated or predictable. They can be related to physical conditions, such as… Cardiac arrhythmia Seizure Syncope Orthostatic hypotension Vertigo/dizziness Pathological fractures Once the causes are identified, treatment can help eliminate future falls.
14	Why do older adults fall more than others? Because of the changes that can occur with aging, older adults often experience one or more risk factors for falls.
15	What are the Risk Factors for Falls? Advanced Age Those age 65 or older are at risk. Those age 85 or older are at greatest risk.
16	What are the Risk Factors for Falls? Being female and/or white. Wearing glasses or having other visual problems that can alter depth perception, visual acuity, peripheral vision, and increase susceptibility to glare.
17	What are the Risk Factors for Falls? Individuals that exhibit altered emotions or mental status are higher at risk for falling. These can include: Agitation Aggressiveness Depression Delirium Dementia Intermittent Confusion
18	What are the Risk Factors for Falls? Individuals that are admitted to the hospital or long term care facility are at risk for falls related to new and unfamiliar surroundings. If the person is moved to a new unit or new room it again puts them at risk.
19	What are the Risk Factors for Falls? Individuals who have previously fallen or who stumble frequently are 2 to 3 times more likely to fall within the next year.
20	What are the Risk Factors for Falls? Having lower body weakness or gait or balance problems. Having physical limitations.
21	What are the Risk Factors for Falls? Individuals are higher at risk if they experience any of these: More that one chronic disease History of stroke Parkinson’s disease Neuromuscular disease Urinary incontinence A drop in blood pressure upon rising
22	What are the Risk Factors for Falls? Taking more than four medications or using psychoactive medications. Wearing shoes with thick, soft soles.
23	Fear Can Lead to Falls Fear of Falling increases with age is higher in older women is experienced by older adults who have fallen and those that have not Warning Signs holds onto people or furniture when walking walks slowly, takes small steps expresses a fear of falling
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25	Fall Risk Assessment All patients should be screened by a nurse for fall risk: on admission whenever there is a change in patient’s condition every 90 days in the LTC setting
26	What Should a Fall Risk Assessment Include? Utilizing the assessment tool available at your facility… evaluate the patient’s mental status obtain the patient's history of falls or tripping observe the patient’s ambulation, gait and balance assess the patient’s vision, hearing and blood pressure
27	What Should a Fall Risk Assessment Include? Utilizing the assessment tool available at your facility… review the patient’s medications review pre-disposing medical conditions assess the environment for hazards
28	Patient At Risk for Falling! You have determined that your patient is at risk for falling. Let’s review some simple interventions that can help prevent falls.
29	Interventions to Help Prevent Falls Make sure that essential items are within easy reach of the bed and/or chair. This can include the telephone, water, call light, eyeglasses, television remote, and other frequently used items.
30	Interventions to Help Prevent Falls Ensure call light is accessible. Remind patients to use the call light anytime they become weak or need help.
31	Interventions to Help Prevent Falls Teach patients not to use moveable objects to help them keep their balance, such as over bed tables, IV poles, chairs. Keep the pathway to the bathroom clear.
32	Interventions to Help Prevent Falls Keep beds in low position. Avoid the use of both side rails as patients will climb over the top of the rail or the end of the bed to exit, increasing the chance of falls.
33	Interventions to Help Prevent Falls Monitor confused or restless patients. Utilize bed or chair alarms when indicated. Place at-risk patients close to the nurses’ station.
34	Interventions to Help Prevent Falls Teach the patient to rise from the bed or chair slowly to prevent dizziness. Remind patients to call for help if they feel weak, dizzy, or lightheaded when getting up.
35	Interventions to Help Prevent Falls Review the patient’s medications and have physician eliminate unnecessary ones. Look for medications that may cause: Dizziness, disorientation or confusion Impaired memory or judgment Unsteady gait, imbalance, or weakness Drowsiness Lack of coordination Talk to physician about possible alternatives when such medications are in use.
36	Interventions to Help Prevent Falls Ensure that assistive mobility devices are in proper working order. Check walkers and canes regularly to ensure rubber tips are intact. Check wheelchairs regularly to ensure that brakes work and lock properly. Have equipment evaluated by Physical Therapy for proper fit and safety. Demonstrate, to the patient and family, the correct use of the equipment.
37	Interventions to Help Prevent Falls Perform a visual inspection of the patient’s room. Make sure room is clutter and hazard free. Make sure locks on bed wheels and wheel chairs are in working order. Educate the patient and family members about environmental hazards at home.
38	Interventions to Help Prevent Falls Instruct the patient to wear properly fitting shoes or slippers with a nonskid surface at all times. Avoid shoes with thick, soft soles, like jogging shoes. Patients should not go barefoot, or wear socks without shoes, even when alone in their rooms.
39	Interventions to Help Prevent Falls Encourage patient to participate in exercises that improve lower body strength and balance to reduce the risk of falls and fall – related injuries.
40	Interventions to Help Prevent Falls Educate the patient to: Use caution when turning corners, entering corridors and rooms Be careful in crowds Get assistance with fallen objects or use a reaching device Have spills cleaned up immediately Use adequate lighting Wear proper footwear (nonskid) Be careful when walking outdoors related to uneven surfaces
41	Interventions to Help Prevent Falls Interventions should be discussed with the patient and/or family. Add interventions to the patient’s care plan, and discuss so that all members of the healthcare team are aware of the plan.
42	What to do if a patient falls… Follow your facility’s procedure for a fall Observe for injuries such as: Scrapes or abrasions Bumps, swelling, or bruises Skin cuts or lacerations Sprain or broken bones Obvious bumps or bleeding from the head
43	If a patient falls… Call for help immediately and do not move patient if you suspect or observe: A head injury Signs of stroke (mouth drooping, slurred speech), inability to move one or more extremities Severe pain with movement; extremities at odd angles or misshapen Uncontrolled bleeding or shock
44	If a patient falls… Obtain vital signs Alert physician of fall and request guidance on transfer if necessary
45	If a patient falls… Perform a post-fall assessment on the patient to help determine cause for fall. Monitor patient for signs of distress if s/he is not transported out of facility.
46	What should a Post-Fall Assessment include? Utilizing the post-fall assessment tool available at your facility… Record the location and time of the fall Indicate the status of the environment at the time of the fall, such as: call bell within reach; lights on; glare on floor; floor wet, etc. Indicate the mental and physical status of the patient at the time of the fall and record any changes that had occurred in the patient’s healthcare status, such as: new medications; BP change; dizziness; pain; infection; behavior changes, etc.
47	What should a Post-Fall Assessment include? Utilizing the post-fall assessment tool available at your facility… Record vital signs and history of previous falls. Ask patient what they were doing at the time of the fall. Document what mechanical/assistive devices were in use, such as: walker; cane; wheelchair; chair/bed alarms, etc. Indicate if mechanical and assistive devices were in good repair and working order. Review medications in use at time of fall.
48	In Summary Falls are the leading cause of emergency room visits each year. In the hospital setting, patient falls are the most common reported occurrence. In the nursing home setting more than 50% of residents fall annually. One third of community dwelling elders fall each year. Accidental falls are the leading cause of death in those over age 65.
49	In Summary Factors that put patients at risk for falls include: advanced age visual problems altered emotions and/or mental status unfamiliar surroundings history of falls lower body weakness pre-disposing medical conditions taking four or more medications exhibit fear of falling
50	In Summary All patients should be screened by a nurse for fall risk: on admission whenever there is a change in patient’s condition every 90 days in the LTC setting
51	In Summary Fall risk assessment should include.. Evaluation of the patient’s mental status A review of patient's fall history Observation of the patient’s ambulation, gait and balance Assessment the patient’s vision, hearing and blood pressure A review the patient’s medications A review pre-disposing medical conditions An assessment of environmental hazards
52	In Summary If a patient falls… follow your facility’s procedure call for help immediately observe for injuries alert the physician of fall perform a post-fall assessment document according to facility policy educate the patient and family regarding fall prevention
53	Post Examination