Falls Risk Management

Transcription

1 Approved by: Vice President and Chief Medical Officer; and Interim Vice President and Chief Operating Officer Applicability: Organization wide Corporate Policy & Procedures Manual Number: VII-B-435 Date Approved September 29, 2016 Next Review (3 years from Effective Date) October 2019 Purpose To provide Covenant Health facilities and patient/resident care providers the framework and tools for development of appropriate falls management strategies which will help reduce patient/resident 1 falls and falls related injuries. Policy Statement Covenant Health facilities and programs shall adopt and implement an appropriate falls risk management strategy(ies) aimed at minimizing the risk and injury related to falls. To achieve the goal of reduced falls and fall related injuries, Covenant Health will: address the specific needs of the patients/populations identified at risk for falls and put into place individual risk mitigation strategies that optimize patient autonomy and freedom of movement apply universal falls preventions strategies for all patients provide falls risk awareness resources to patients and family collect and analyze falls related data; and use fall related data to make improvements to the falls risk management strategy. Principles The Falls Risk Management policy reinforces Covenant Health's philosophy and commitment to improve patient safety. Covenant Health recognizes that all people live at risk for falling and patients receiving health services have additional risk factors associated with acute and/or chronic conditions that may increase their likelihood of a fall with or without injury. Covenant Health acknowledges that despite best efforts to provide safe, quality care, patients may fall resulting in injury. Falls prevention and risk management strategies will be executed across the continuum of health services. Covenant Health programs implement falls risk management strategies that reflect the characteristics of the patients/populations they serve. Definition Fall means unintentionally coming to rest on the ground, floor or other lower level with or without an injury. 2 1 Hereafter, all references to 'patients' includes residents and clients. 2 Registered Nurses Association of Ontario. (revised, 2011). Prevention of Falls and Fall Injuries in the Older Adult. Toronto: Canada. Registered Nurses Association of Ontario.

2 VII-B-435 Page 2 of 7 Policy Elements 1.0 Prevention 1.1 Evidence informed universal fall prevention activities will be incorporated into all falls risk management strategies and applied to all populations. 2.0 Screening and Assessment 2.1 Inpatient Programs/services (and other programs/services if patient status indicates) will use screening /assessment tools to identify the patients at risk and determine their specific individual risk factors and needs. 2.2 Risk assessments of patients will be conducted by those with the appropriate skills and knowledge, involving members of the interdisciplinary team as applicable. 2.3 The patient s risk for falls will be communicated through the standardized team communication processes pertinent to the programs area and visually communicated in layman s terms in the patient room in conjunction with the patient s functional assessment. 2.4 Inpatients will be assessed for falls risk on admission to the unit, with significant changes in health or mobility status, post-fall and on transfer/discharge from the unit. 2.5 The patient s fall risk assessment or reassessment will be documented in their health record using the applicable standardized falls risk tools for the program area. 2.6 Patients and family members (if applicable and appropriate) will be provided with information regarding the individual patient fall risk. 3.0 Intervention 3.1 Universal falls prevention strategies will be implemented as appropriate for all patients with the level of interventions dependent upon the patient/population's assessed risk level, identified risk factors, and individual needs. Multi-factorial interventions will be used. 3.2 Interventions will be reviewed and edited as necessary with each fall risk reassessment. 3.3 Post fall intervention and documentation will be recorded using a post fall protocol and tool for the program area. The use of a post fall huddle is encouraged. For Post Fall procedure refer to Appendix Data Collection and Measurement 4.1 Patient falls will be reported in the Reporting and Learning System, per Covenant Health policy #III-45, Responding to Adverse Events, Close Calls and Hazards

3 5.0 Evaluation VII-B-435 Page 3 of Individual patient falls risk mitigation strategies will be reassessed and modified as patient status indicates or during the completion of a post fall report/huddle. 5.2 The patient/family should be included in the post fall review/huddle and any new interventions or information explained. Patients should be updated on any changes to their functional mobility status as assessed by staff. 5.3 Standardized processes for the evaluation of falls event data will facilitate ongoing examination of falls risk management strategies. Data related to falls will be evaluated and used to inform falls risk management strategies at the patient level, program level, and organization level as applicable (i.e. RLS dashboards, audit results). Procedure Utilize resources for the following program areas; Inpatient Acute Adult Emergency (separate resources for Rural and Urban) Continuing Care/Supportive Living Ambulatory - in development Pediatric inpatient in Resources include; algorithms, fall risk assessment tools/forms, post fall report forms, clinical pathway documentation sheets.

4 VII-B-435 Page 4 of 7 Appendix 1 Post Fall Procedure 1. Assess any patient who falls or reports a fall and manage according to condition and individual patient needs: a) Assess for injury and provide immediate care. b) Place the patient in a position of safety and comfort unless contraindicated by a suspected spinal cord injury where moving the patient could potentially cause further harm. c) Intervene for the severity of injury and seek immediate assistance as necessary and appropriate to the situation (physician, rapid response team or EMS). d) Notify staff in charge or the appropriate manager/supervisor regarding the fall. e) If patient is stable and has no obvious signs of injury, notify the attending physician or designate as appropriate and applicable to the patients status. f) Notify family member or legal decision maker as applicable and appropriate and document in the clinical health record. (see Covenant Health Corporate Policy #III-40, Disclosure of Adverse Events, Close Calls and Hazards). 2. Monitor patient as condition dictates: a) Monitor patient for injuries that may not be immediately visible or that may be delayed; such as head injury, intracranial bleeding, fracture and spinal cord injury. b) Frequency of monitoring will be as the patient s condition indicates, (or in continuing care as outlined in the post fall algorithm) c) Patient assessment may include but is not limited to: i. vital signs ii. neurological vital signs: mandatory where a suspected head injury may have occurred. iii. inspection for injury (bumps, bruises, lacerations, etc.) iv. pain v. abnormalities or change in range of motion or functional ability vi. any change to baseline(physiological or cognitive functioning) vii. changes in behavior d) Document post fall assessment on the post fall report indicating any additional charting with its location in the clinical health record. e) Document any patient care orders from the most responsible health practitioner/ delegate in the clinical health record. f) Any test results will be followed up and interventions as warranted by the physician/delegate.

5 VII-B-435 Page 5 of 7 3. Post Fall reassessment of fall risk factors. a) Complete a post fall report. b) Complete falls risk assessment tool pertinent to the program area again and modify risk interventions as applicable. c) The patient s falls risk reassessment will be documented in the health record in the program/services area using the applicable standardized tools for the program area and communicated through the standardized team communication processes pertinent to the programs. 4. Modify care plan and document changes in intervention in the clinical health record. 5. Patient falls will be reported in the Reporting and Learning System, per Covenant Health policy #III-45, Responding to Adverse Events, Close Calls and Hazards.

6 VII-B-435 Page 6 of 7 Related Documents Covenant Health policy #III-45, Responding to Adverse Events, Close Calls and Hazards Appendix 1 Post Fall Procedure. Take Action: Prevent a fall before it happens. (Patient and family education booklet) ASK 3 and Universal Fall Prevention posters and lanyard cards Path to Home documents Inpatient Falls Risk Management Schmid fall risk assessment tool ED Falls Risk Management Nursing Care Assessment Record ED Adult Falls Risk Screen Pediatric Falls Risk Screen (TBD) Continuing Care Falls Risk Management Scott Fall Risk Screen Acute Care Post fall report Continuing Care Post fall algorithm and tool Alberta Health Services University of Alberta Hospital Post Fall Tool Alberta Health Service University of Alberta Hospital High Falls Risk Mitigation tool References Alberta Health Services Falls Risk Management Level 1 Policy policy.pdf Alberta Health Services Falls Risk Management Tool kit Alberta Health Services Post Falls Review Monitoring Schedule July Clinical Practice Guidelines: Reduction of Falls and Related Injuries in Acute Care. Fraser Health Authority. October 30, Poss, J. (2009). Risk Factors for Falls in Residential Care: Evidence from RAI MDS 2.0 Assessment Data. Paper presentation at the Residential Care Summit, Victoria BC, November 5-6, Kinder 1 Falls Risk Assessment Tool. Alexander, Danette RN, MSN, NEA-BC, Kinsley, Terry L. RN, MSN, CEN, and Waszinski, Christine RN, MSN, GNP-BC, Hartford, CT. Journey to a Safe Environment: Fall Prevention in an Emergency Department at a Level 1 Trauma Center. J Emerg Nurs 2013;39: Safer Health Care Now Falls Getting Started Kit Revised April ng%20started%20kit.pdf Universal Fall Prevention (UFP) and ASK 3, adapted with permission, Fraser Health Authority, British Columbia, 2009 Registered Nurses Association of Ontario. (revised, 2011). Prevention of Falls and Fall Injuries in the Older Adult. Toronto: Canada. Registered Nurses Association of Ontario. Schmid, NA (1990) Reducing Patient Falls: A Research-Based Comprehensive Fall Prevention Program. Military Medicine, 155, 5:202, Scott V, Votova K, Scanlan A, Close J. Multifactorial and Functional Mobility Assessment Tools for Fall Risk Among Older Adults in Community Home-support, Long-term Care and Acute Care Settings. Age Ageing. 2007; March; 36(2): Scott, V. (2012). Falls Prevention Programming: Designing, implementing and evaluating

7 VII-B-435 Page 7 of 7 Falls Preventions Programs for older Adults. Raleigh, North Carolina: Lulu Publishing. Scott, V. (2012) Scott Falls Risk Screen. Residential Long-term Care November National Institute for Health and Care Excellence (NICE) Clinical practice guidelines for the assessment and prevention of falls in older people. Finding Balance Alberta: Prevention of Falls and Fall Injuries in the Older Adult. Registered Nurses Association of Ontario (RNAO) Best Practice Guideline, Preventing Falls: From Evidence to Improvement in Canadian Health Care, A Collaboration From Accreditation Canada/ the Canadian Institute for Health Information/ the Canadian Patient Safety Institute, 2014