1. FALLS IN THE GERIATRIC POPULATION MED/SURG ACUTE CARE UNIT

2. THE PROBLEM - AN INCREASE IN FALLS  Over the past 12 months the fall rate has risen dramatically.  From approximately 12% to 32%.  There has been a large turnover in staffing  One –third of the nursing staff are new grads  The floor is short staffed on overnight shifts  There are seldom techs for the floor at night

3. THE PLAN….  A change must be implemented to address this issue.  The new policy will require that bed/chair alarms be set and documented with each visit in the room.  Since the current requirement is hourly bed checks, the expectation is that the bed/chair alarms will be documented hourly.

4. BASIC ON ASSESSMENT….Every time! ■■ Ask about falls history. ■■ Ask about fear of falls. ■■ Check if footwear is safe. ■■ Check call bell is in reach, if able to use. ■■ Check clear communication of mobility status. ■■ Check personal items are in reach. ■■ Check walking aids are in reach, if used. ■■ Check there is no new night sedation. ■■ Cognitive screen, if aged over 70 years. ■■ Check decision to use/not use bedrails is appropriate.

5. MORE….  By setting and documenting alarms, will increase the likelihood that a nurse or aide will respond to movement.  Will monitor for 6 month period, with periodic checks to see that alarms are being documented in the system.  Assess and re-evaluate.  Make changes as necessary.

6. BACKGROUND….  Falls are a leading cause of hospital-acquired injury  Prolong or complicate hospital stays ( CDC, 2013)  Falls result from a myriad of factors  These factors complicate the evaluation/management of fall risks  Falls in the elderly result in medical morbidity  They are costly to the health care system.

7. RISK FACTORS FOR FALLS MAY BE EITHER INTRINSIC… … patient-related  cognitive  confusion  dementia  sex  Male or female?  physiological conditions  vision disturbances  gait and balance disturbances  incontinence  weakness  dizziness.

8. OR EXTRINSIC… … environmental  Clutter  IV poles and lines  Lighting  Railings  bed position  loose cords  spills

9. COMORBIDITIES AND HIGH RISK MEDICATIONS… Parkinson's disease Osteoporosis history of stroke arthritis Psychotropics benzodiazepinessedatives anticonvulsants antidepressives (SSRI. TCAs)antihypertensives analgesics /opiates anticholinergics antihistamines Antiarrhythmicsantithrombotics / anticoagulants

10. KEEP IN MIND SOME STATISTICS….  The population of US adults 65 years and older will double during the next 25 years.  By 2030, it will number 71 million, comprising 20 % of the population.  Approximately one-third of persons 65 years and older experience one or more falls each year. (Naqvi et al, 2009)

11.  Falls have not only physical consequences, but also financial and emotional implications.  Researched interventions to prevent falls include medication review, fall alarms, and environmental aids.  Nurses play a vital role in developing plans for fall prevention.  More than 70% of these adverse events are considered preventable (Graham, 2012)

12. WATSON’S THEORY OF HUMAN CARING…  Watson’s nursing theory focuses on the human component of caring (Kearney-Nunnery, 2008).  caring is a moral ideal  caring encompasses a mind-body-spirit engagement between the caretaker and patient.  considers each interaction between the nurse and the patient  role for nursing would be defined by interaction with the population.

13. INTEGRATION OF WATSON’S THEORY IN NURSING PRACTICE (RIGHT, 2012)  Treat patients as holistic beings  Display unconditional acceptance.  Treat patients with positive regard.  Promote health through knowledge and intervention.  Spend uninterrupted time with the patient.

14. IT IS EVERYONE’S JOB…. Autonomy—agreement to respect another’s right to self-determine a course of action; support of independent decision making. Beneficence- compassion; taking positive action to help others; desire to do good; core principle of our patient advocacy. Nonmaleficence- avoidance of harm or hurt; core of medical oath and nursing ethics. Fidelity- This principle requires loyalty, fairness, truthfulness, advocacy, and dedication to our patients. It involves an agreement to keep our promises. Justice- this principle refers to an equal and fair distribution of resources. Decisions about diagnosis, therapy, and prognosis for the patient. Based upon the health care professional’s belief about what is in the best interest of the patient.

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16. REFERENCE Center for Disease Control (CDC). (2013). Injury and violence prevention and control. Retrieved 9/24/2013 from: http://www.cdc.gov/injury/index.htmlhttp://www.cdc.gov/injury/index.html Graham, Bridget C. (2012). Examining Evidence-Based Interventions to Prevent Inpatient Falls. MedSurge Nursing. 21:5, 267-270. Jorgenson, John. (2013). Reducing patient falls: A call to action. Retrieved 9/25/2013 from: http://www.americannursetoday.com/article.aspx?id=7634 Kearney-Nunnery, R. (2008). Advancing your career: concepts of professional nursing (4th ed.). Philadelphia, PA: F.A. Davis. Pp.73-74. Naqvi, Fatima, Lee, Susan, & Fields, Suzanne D. (2009). An evidence-based review of the NICHE guideline for preventing falls in older adults in an acute care setting. Geriatrics. 64:3, 10-13. Right, Jocelyn. 2012. How to Integrate Jean Watson’s Theory of Caring Into Nursing Practice. Retrieved on 9/25/2013 from: http://www.ehow.com/how_6644521_intergrate-theory-caring-nursing- practice.html#ixzz2DoEAJs4khttp://www.ehow.com/how_6644521_intergrate-theory-caring-nursing- practice.html#ixzz2DoEAJs4k