Fall Prevention and Safety Emily Fontaine, SPT

Overview The importance of fall prevention Assessing the risk of a patient Fall Precautions Safety with transfers Patient education My goal for today is to get you as new employees acquainted with our protocols and familiar with how we prevent falls. I hope that after this presentation you will have a good basis on our ambulation and transfer strategies as well.

Why Fall prevention? Falls are the leading cause of injury death in people 65 and older Falls make up the largest category of reported incidents in hospitals Patients who fall often sustain injuries that lead to hospitalizations Injuries include fractures, soft tissue injury, and head injury.

An activity An activity before we begin: Get a pair of glasses Walk around with the glasses on Trying going upstairs With this activity I have glasses with Vaseline on the lens. I want you to see what it feels like to experience poor vision and how that affects falls. Also, many falls happen on the stairs so please try walking up and down stairs to assess the difficulty of that task.

Activities Cont. Think about our patients who have physical weaknesses and balance problems on top of their bad eye sight. It is incredibly easy to fall! Their safety is extremely important

How to assess a patient’s risk Morse Fall Scale (MFS) is used with all patients to assess fall risk Nurses will perform this test, but the entire medical team will utilize it

MORSe Fall Scale (MFS) United States Department of Veteran Affairs This is the criteria for assessing the risk of a patient. From both the patient history and evaluation of the patient this data can be compiled. Simply add up the scores from each of the categories to find a patient’s score. United States Department of Veteran Affairs

Do the math! You are asked to complete the MFS for a new patient, Ted. Ted fell a week ago while in acute care at MGH. He uses a rolling walker because his strength is weak and is a moderate assist for walking. He doesn’t need an IV pole and has normal mental status what would his MFS number be? 50 Even if you are not a nurse here is a practice for assessing the MFS scale.

Risk level with morse scale No risk: 0 – 24 points Low risk: 25-50 points High risk: 51 points or greater Ted will be a low risk, but very close to high. This is a patient that will need to be monitored very closely during transfers and gait.

fall prevention Status Low Fall Risk: 25-50 on MFS Assess the patient’s coordination and balance before transferring or mobilizing the patient High Fall Risk: 50 or more on MFS This will be made clear in the patient chart Use bed alarms, bed rails, and a sitter if necessary so patient does not get out of bed without assistance Make sure medications to decrease fall risks are taken on schedule

Transferring Know the patient’s transfer status (independent, minimal assist etc.) and fall risk While transferring Make sure the bed is lowered and locked Move any possible obstacles that are on the floor Have the patient wear shoes or treaded socks Block the patient’s knees if necessary Transfer patients towards their strong side Don’t allow patients to lean on moveable equipment We will now demonstrate two transfers The transfer status of the patient is determined by the physical therapist assigned to the patient upon the patient’s arrival. Be especially careful with those patients that have a high fall risk when transferring. We will be demonstrating a minimal and maximal assistance. (I will then ask for a volunteer) Minimal assistance: Have patient sit up in bed, make sure the patient has any assistive device he or she uses, and assist patient in standing up and getting into the chair or wheelchair. You may have to cue the patient in each of these steps. The patient’s chart will note if a gait belt is necessary for the transfer. Maximal assistance: With a maximal assist transfer the patient will need maximum cueing and assistance with the movement. Make sure you have the patient’s wheelchair correctly positioned before starting. Assist the patient in rolling onto his or her side and then sitting up. Put the gait belt onto the patient and block the patient’s knees. Have the patient assist you as much as they can while you grab the gait belt and swing the patient into the wheelchair.

Ambulation Know the risk of the patient Use gait belts and assistive devices when necessary Use the Berg Balance Scale Assesses independence See Physical Therapy Floor Manager for more details We will now demonstrate how to utilize the gait belt Use the Berg Balance Scale to diagnose balance impairments in your patients Good way to assess if the patient is able to ambulate independently These tests can be done by physical therapists. All members of staff should know what the scores mean, but not how to do the tests For the demonstration: Could I please have a volunteer When you put a gait belt on make sure it is around the hips not the stomach and that it is on snuggly. When walking with a patient keep a hand on the gait belt and give assistance. The amount of assistance given depends on if the patient is a minimum assist, moderate assist, or maximum assist. Berg Balance Test

Patient education Do: Don’t: Wear appropriate footwear Arrange furniture so you can walk easily Install railings on the stairs and nonslip mat in shower Use a night light Don’t: Walk and talk at the same time Attempt a task that’s too difficult that will cause you to get tired while doing it Walk in the dark When patients leave the hospital for home or another facility there are some important things we as health care professionals need to make them aware of These tips will help your patients be safer at home and make them less at risk for falls The more time they hear this information the better so do not be afraid to repeat this information even if another health care professional may have already done so If relevant you can discuss the option of Lifeline support with the patient when he or she is being discharged home

Questions?

Works cited Care Company Website. http://dev.thecarecompany.biz/. Accessed October 20, 2012. “Fall Prevention.” In Total Home Health. Accessed October 8, 2012, from http://www.totalhomehealthinc.com/fall-prevention.htm. “Fall Prevention in Hospitals.” Premier. Retrieved October 8, 2012, from https://www.premierinc.com/safety/topics/falls. Pelczarski and Wallace. (October 15, 2009). “Hospitals Collaborate to Prevent Falls.” In Patient Safety and Quality Healthcare (PSQH). Accessed October 8, 2012, from http://www.psqh.com/novemberdecember-2008/91-november-december-2008/277-hospitals-collaborate-to-prevent-falls.html. “VA National Center for Patient Safety.” United States Department of Veterans Affairs. Accessed October 8, 2012, from http://www.patientsafety.gov/CogAids/FallPrevention/index.html#page=page-1