Falls Prevention
Shawna Cassidy, Physiotherapist
Shoshana Berliner, Occupational Therapist
North York General HospitalMarch 2006
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 Improvements, a fall also includes “patients assisted to the floor”.
Overview
Definition of a fall Importance of fall prevention (incidence and
outcomes)Fall risk factorsOverview and goals of Falls ProgramWhat is involved in the Falls ProgramAssessment of fallsFalls interventionsProgram Outcomes
Incidence of falls
What?Who?When?Where?Why?
Outcomes of falls
psychological effects (fear of falling) decreased level of functioning and
independence injuries mortality delayed discharges
Case Study
Risk factors: Environmental
poor lightingfloor surfacesunsteady furnituretelephone, call bells
not in easy reachheight of seatingcluttered pathways
ill-fitting clothing, diapers
non-working hearing aids
dirty or improper eyeglasses
inappropriate footwear
Risk factors: Physical
agehistory of fallsillnessneurologic diseasemobility or balance impairmentpostural hypotensionsensory impairmentsincontinencypoor nutrition
Risk Factors
CognitivePharmacological
(benzodiazepine/sedatives, polypharmacy >5 meds)
Overview of Falls Prevention Program
Need for programPatient safetyMultidisciplinary approach
Program will only work if everyone helps out!
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 Monitoring of incidence, time and location of
falls, severity of injury and overall effectiveness of the program
Procedure
Flow chart
Falls Screening
SPPICES
Assessment
SPLATT (Falls History)S - symptoms at time of fall(s)P - previous number of falls or near fallsL - location of fall(s)A - activity at time of fall(s)T - time of fall(s) and time on groundT - trauma or injury with fall(s) [physical,
emotional]
What happens after a fall
Incident Report
Interventions: Cognition
Simplify tasksAvoid changes or make changes
graduallyRemove excessive stimulationUse clear, concise communicationProvide consistency in staff and routineProvide orientation cues (calendars,
clocks)
Interventions: Cognition
Increase light at twilightProvide meaningful activityFollow “Least Restraints Guidelines”Encourage family members/friends/sitters to
remain with patient
Interventions: Physical Status
Place hearing/visual aids close byEncourage toiletting routine (q2hrs)Provide bedside commodeEnsure urinal is within reachReduce fluid intake after dinnerEnsure patient maintains adequate nutritionEncourage patient to dangle before
standing/walkingEncourage patient to perform ankle pumping in
sitting position before walkingEncourage patient to sit down immediately if
feeling dizzy
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 techniques for transfers, ambulation
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 techniques with patient and/or family
Interventions: Environmental
Ensure height of bed/chair is at level where the patient’s feet touch the floor
Keep bottom bedrails downEnsure easy access to call bell,
radio/tv controlsEnsure improved lighting, minimize
glareMaintain straight paths to bathroom
Interventions: Environmental
Use bedside commodes for patients who can transfer independently but are unsafe to ambulate independently to bathroom
Ensure clean, dry floorsPlace higher risk patients in room near nurse's
stationPlace higher risk patients in bed by
bathroomEnsure brakes on equipment are
operational
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 usePlace IV equipment at top of bedEnsure nightlights are operational and in usePush bed against wall; place mattress on
floor, beside bed, if patient climbing out of bed
Interventions: Meds
Review medication list for drugs which may predispose patient to falls
Decrease use of benzodiazepinesDiuretics given in the morning
Community Resources
Day HospitalFalls ProgramsCCACDay ProgramsEmergency Response SystemsMOWAssistive Devices ProgramWheel Trans
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 injuries secondary to falls
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