Post Fall- Preventing Future Falls. A look at process- everyone's responsibility.

Transcription

1 Post Fall- Preventing Future Falls. A look at process- everyone's responsibility. Thursday, November 15, 2018 Daphne Kemp THIS WEBINAR IS BEING RECORDED. THE SLIDE DECK AND RECORDING WILL BE ED AFTER THE WEBINAR. Webinar technology managed by:

2 Post Fall Preventing Future Falls A look at Process - Everyone s Responsibility Everyone s Responsibility November, 2018 Daphne Kemp Fall Reduction and Injury Prevention Coordinator, RSW

3 Falls Reduction and Prevention What we will be discussing today: r Back to basics On-going assessment Identifying risk factors Care planning - Interventions Post fall - Use of data and evaluation - Communication - Documentation

4

5

6 Fall Prevention Why are we focusing on Falls? Falls are the leading cause of injury, deaths, hospitalizations, (permanent total and partial disabilities) among older Canadians(Parachute, 2015) 50% of those that fall will do so repeatedly The risk of sustaining a hip fracture is 10.5 times higher for women who are in facilities such as Long Term Care Homes than those in community.

7 Fall Prevention

8 Fall Prevention Video: Falling in Long Term Care atch?v=1ekkwvouvpg

9 Considerations Fall Prevention in LTC What do we need to consider? Every person that enters our care should be considered at risk for falls Falls primarily occur due to a loss of balance and an inability to recover balance The risk factors for falls are compounding and interrelated There is rarely, if ever, only one risk factor

10 Fall Prevention Processes Process can be the same across the continuum

11 Falls Reduction and Prevention Processes: Identification of risk factors holistically Creating meaningful interventions Communication & documentation Ongoing education

12 Findings within our area Residents who fall are often confused, weak, frail older adults Residents are not asking for assistance for various reasons Falls are happening unwitnessed in people s rooms and are often connected with toileting, urgency or incontinence or people getting in and out of bed

13 Falls Prevention Reduction Intervention Model Strategy 1. Prevention: Universal falls precautions (SAFE) 2. Multifactorial screen Comprehensive risk assessment 3. Communication and education about fall risk 4. Implement interventions /actions 5. Additional interventions for those at high risk of fall related injury

14 Myths : We can t do anything to prevent falls People fall because they are older We need to restrain people to keep them safe It takes too much time to prevent falls They just fell

15 Use of Assessments How are we identifying fall risk factors? MORSE NISS FES Environmental Ax MDS SCOTT Medication review

16 Fall Prevention Action Have you used your assessments to create individualized planning for safety? Is this present and up to date? A process for environmental checks should be established and maintained Routine safety checks implemented - should it increase? Increased monitoring and or rounding has been identified as a means to decrease falls especially on new residents or patients with a change in status such as an infection or fall. We then need to Document and Communicate so everyone knows the plan and so we can improve process

17 Fall Prevention Despite our best intentions A fall Occurs Now what?

18

19 Tools

20

21 Falls Reduction and Prevention Falls Prevention Post Fall: Preventing Consecutive Falls Remember it is a combination of factors!!! What was going on at the time of the fall? How were they found?

22 Therapeutic Interventions What do we want to know? Time of day Circumstances - any recent changes Injury Past falls; is there a pattern? Any medication changes Environment - anything odd

23 Huddle Guidelines As many team members available, including patient/resident when possible, should attend the huddle. Outline a plan to prevent falls: Date held Who is in attendance? What contributed to the fall? What was the direct result of the fall? What interventions are needed? What assistive devices are needed? Does the patient/client/resident require further education on use of the above devices? Communicate this plan with staff, patient/resident and/or family Document plan in Care Plan/Patient Profile and update in Progress Notes

24 Communication Documentation & Communication We must communicate with the person and/or family regarding planning Education about fall risk factors and fall prevention to the: Client/Patient/Resident Family All team members How best can the risks be communicated in a meaningful and respectful way?

25 Considerations Balancing safety and risk Have we tried something in the past that did not work then but may now? Have we created the safest environment for this resident? Have consulted everyone that needs to be involved. Have we looked for patterns?

26 Fall Prevention Setting residents up for success The P s: 1. Positioning 2. Personal Needs 3. Pain 4. Proximity of Personal Items Can you think of others that support fall Prevention?

27 Fall Prevention Relationship: Pain and Falls Need to understand relationships of risks e.g. pain as a risk factor How does pain impact us? Mobility Function Quality of life What is the prevalence?

28 The Risk Factors Add Up Pain Mood Decreased Sleep Confusion Irrability Depression Concentration Insight Impulsive Stop Moving Stay In Bed Weakness Isolate Balance Deconditioning Breathing Altered Illness Constipation Given Bowel Care Agitation Medications: - Sedation - Mood Behavior - Pain Increased Confusion Anxious Unsettled More Pain from Inactivity Feelings of more Loss disappointment Drowsy Blood Pressure Vertigo / Dizziness Skin Breakdown Stop Eating Exhaustion Stop Moving Weakness Weakness Different Pain FALL

29 Lets Add Environment Compounding Risk Factors

30 Fall Prevention Targeted Activity Encourage active lifestyle - both physically and socially Exercise Decrease sedentary time Meaningful activities and purposeful interactions Be resourceful,

31 Fall Prevention How does falling make us feel? Frustration Anger Loss Disappointment Defeat/Despair Why Me Sad Depressed Guilt Anxious Stupid

32 Fall Prevention Injury Prevention and Safety Measures There are times when despite our best efforts a person has continued falls due to individual s complex risk factors or their choice to live at risk We can work to prevent fall related injuries, do you know when to use each kind of safety measure? We have tools and skills. We need to look at the person holistically and look at root cause on going. Health status changes, we must continue to assess update care plans and communicate.

33 Long Term Care Injury Reduction Ensure the bed is in the lowest appropriate position with wheels locked, if assessed to do so Consider safety accessories such as floor mats, alarms and one way glides/ hip protectors - based on assessment Vitamin D Use of transfer or mobility aids Ensure resident needs are met

34 Data A look at Quality Indicator What are they and can we use them post fall? The Ministry of Health s Quality Indicator Improvement Initiative includes these seven quality indicators: Prevalence of people: with daily physical restraints Given antipsychotics without a relevant diagnosis Pain worsened With a new pressure injury With a worsened pressure injury Whose urinary continence worsened Who fell (in the last 30 days)

35

36 Next Steps Next Steps We must have processes in place that identify fall risk and ensure residents have a fall prevention and injury reduction plan in place We must communicate in an effective way and streamline our processes while being inclusive and involving the entire team including resident and family We must document and evaluate our efforts for improvement. We must use the data.

37 References Long Term Care RNAO Best Practice Guidelines, 2017 Reducing Falls and Injuries from Falls Getting Started Kit safer healthcare now, RNAO Canadian Falls Prevention Curriculum Training June 9, 10 Saskatoon Scott, V. (2017). Fall Prevention Programming: Designing, Implementing and Evaluating Fall Prevention Programs for Older Adults. Raleigh, North Carolina: Lulu Publishing. And Canadian Fall Prevention Curriculum: Susan Tupper, PT, PhD Strategy Consultant, Pain Quality Improvement and Research

38 Long Term Care References Resident Assessment Instrument RAI-MDS 2.0 User s Manual (2012) esources/rai%20mds/user%20manual%20info/users%20manual% pdf interrai Clinical Assessment Protocols (2008) ews%20and%20updates/mds%20upgrade/interrai%27s%20clinical%20 Assessment%20Protocols%20Manual%20(March%202008).pdf RX Files (Pain Management in LTC) - Pain Assessment for People Unable to Communicate The American Geriatric Society - CIHI equery -

39 Questions? Type your questions into the chat box. OR Dial *7 on your telephone to unmute. Dial *6 when you are finished speaking to re-mute. THIS WEBINAR IS BEING RECORDED. THE SLIDE DECK AND RECORDING WILL BE ED AFTER THE WEBINAR.

40 More upcoming webinars Thursday, November 22 nd 2018 Vision, Aging, Falls, and Falls Prevention - Part III Presenters: Dr. Lois Calder & Dr. Tammy Labreche

41

42 Thank you for attending! STAY IN THE LOOP!

43 STAY IN THE LOOP!