1. Evaluating Falls CBC News Hour April 9, 2014 CBC Survey Unit

2. What’s the Problem?  The CBC Survey Unit has cited C270— Evaluation and Monitoring—more frequently in the past year. It is often related to falls.  We want to provide assistance to help facilities: Understand the rule; and Understand the rule; and Understand how the rule applies to changes of condition related to falls. Understand how the rule applies to changes of condition related to falls.  So let’s address this…

3. Let’s Look at a Fall Logically  Forget we deal with “residents”. Let’s suppose your mother has fallen. What would you do? Evaluate your mother to determine if she is alright. Give or get care as needed. Keep checking on her. Evaluate your mother to determine if she is alright. Give or get care as needed. Keep checking on her. Try to determine why your mother fell. Try to determine why your mother fell. Figure out what to do so your mother won’t fall in the future. Figure out what to do so your mother won’t fall in the future. Check on your mother to make sure your ideas are keeping her safe. Check on your mother to make sure your ideas are keeping her safe.

4. What Facilities are Doing After a resident falls, this is typically what we see:  Facilities are doing an “immediate” evaluation of the resident: Taking vitals Taking vitals Checking for wounds Checking for wounds Evaluating pain Evaluating pain Checking ROM Checking ROM

5. What Facilities are Doing  And facilities are typically determining immediate interventions: Determining if a hospital visit is required Determining if a hospital visit is required Initiating “Alert Charting” to monitor the resident Initiating “Alert Charting” to monitor the resident Notifying family and physician Notifying family and physician  And some facilities try to identify factors that could have contributed to the fall: “Didn’t use her walker” “Didn’t use her walker” “Had a UTI” “Had a UTI”

6. Evaluating the Fall  Facilities often fail to evaluate why the person fell.  Evaluating means gathering information and asking questions. What did the resident or staff say? What did the resident or staff say? What did the staff observe? What did the staff observe? Have there been any recent changes? Have there been any recent changes?

7. Interventions  Once you’ve identified how or why the resident fell, you will want to develop and implement some interventions.  Think about interventions you might use…  New interventions need to be documented and communicated to staff.

8. An Example  Our resident—Mr. Smith—had two falls.  We developed the following interventions: Remind Mr. Smith to use his walker; and Remind Mr. Smith to use his walker; and Remind Mr. Smith to call the CGs for assistance. Remind Mr. Smith to call the CGs for assistance.  This seemed to work for a couple of weeks. But this week, Mr. Smith has been falling again.

9. Repeated Falls—What Next?  Now, your evaluation of the repeated falls becomes a little more complex:  You still have to evaluate why the person fell again: Same reasons? Same reasons? New issue? New issue? Were staff following the service plan? Were staff following the service plan?  And evaluate the previous interventions: Were they effective? Were they effective? Do we need new interventions? Do we need new interventions?

10. Implemented/Followed?  Staff documentation and follow-up interviews should tell you whether the interventions were being implemented and followed.  If not, is it an issue with: Staff training? Staff training? Communication of care needs? (Staff didn’t review the service plan) Communication of care needs? (Staff didn’t review the service plan) Inadequate staffing to meet the needs of the residents? Inadequate staffing to meet the needs of the residents?

11. Adequate?  Staff documentation and follow-up interviews should evaluate whether the existing interventions are effective in preventing re-occurrence.  If not, you would develop additional interventions. Let’s return to Mr. Smith…

12. We Re-Evaluate  Through the information we gathered from staff, we discovered that Mr. Smith just can’t remember to use his walker or call CGs for assistance. What now?  We will develop and implement some new interventions: for example More frequent checks; More frequent checks; Visual reminders; Visual reminders; Med review; Med review; Physical Therapy; Physical Therapy; Etc Etc

13. Re-Evaluation and Monitoring 1.EVALUATE/RE-EVALUATE Why did the resident fall? 2. INTERVENTIONS We know why the resident fell, what are we going to do about it? 3.MONITORING Evaluate whether interventions are being Implemented and are effective

14. Summary  When an incident, such as a fall, occurs: Evaluate to find out why the resident fell; Evaluate to find out why the resident fell; Determine whether or not the service plan was being followed; Determine whether or not the service plan was being followed; Evaluate whether interventions need to be developed; Evaluate whether interventions need to be developed; Communicate interventions to staff; and Communicate interventions to staff; and Monitor that the service plan is being implemented, and re-evaluate that the new interventions are effective. Monitor that the service plan is being implemented, and re-evaluate that the new interventions are effective.

15. Questions? Thanks! David.e.mackowski@state.or.us Kristina.e.anderson@state.or.us