Presentation on theme: "Quality Improvement in Long Term Care Program"— Presentation transcript:
1 Quality Improvement in Long Term Care Program Falls Prevention
2 Falls Management Program The purpose of a falls management program is to assess each resident fall risk. To assess each resident’s fall risk, ensure the resident’s immediate safety and to ensure further safety and fall prevention through a multidisciplinary approach.
3 FIRST STEPSWe determined the need for an initiative by reviewing and analyzing the Quality Assurance data collected each month.Review current resident falls assessment from pre-admission information to current data.
4 SCREENINGReview resident applications, many are high-lighted for fall risk.On admission (and quarterly) a FALL RISK ASSESSMENT is completed:Identifies history of fallsMedication usedDiagnosis and vital signsMemory and orientationVision and hearing abilityContinence levelMobility status, including gait analysisRelated behaviours
5 RESIDENT CARE PLANWhen a resident is high/medium risk a care plan is developed to identify the risk.FOCUSPotential/ high risk for Falls related to …..GOALPrevention of falls.INTERVENTIONSPlace wheelchair in tilted back position to prevent exit from chair and improve positioning.Check q1h to ensure safety.Have commonly used articles within easy reach.(papers, pen, Kleenx)Transfer and Change positions slowly.Reinforce need to call for assistance, check with resident every 1/2 hour to see if she needs assitancePut 2 siderails up at all times / when in bed for safety.Seat belt is for safety purposes only. Resident is able to removeCall bell with in reach when in bed
6 POST FALL ASSESSMENT Date, time, location Head to toe assessment, ROM ROM, changes to extremitiesSkin condition: abrasions, redness (location, size and colour of injury)PainHead injuryVital signsBlood pressure : lying and standing (if possible)Pulse, respirationsNotify physician and family
7 ENVIRONMENTAL FACTORS LightingCall bell within reachFlooring: wet or cluttered, carpetingFootwearRestrictive clothingGlasses/hearing aide within reachUse of assistive devices
8 THREE TEARED DOCUMENT 1 st Fall 2nd Fall 3rd Fall Reminders to use call bellPhysio. assessment requestedToileting routine reviewedInitiate q1/2 hour safety checkFloor pad placed at bedsideSafety alarm in use when in bedMedical assessmentHip protectorsUpgraded footwearInstalled night light
9 DOCUMENTATION Incident report / line listing Incidental charting (each shift x 3 days or 9 shifts)Present a clear account of incidentFactual, precise, descriptive language recording observationsAction taken, MD directiveVital signsFamily member / SDM: who was notifiedDocument on shift report
10 REFERRALS Pharmacist Physiotherapist Pharmacological review Makes recommendations to MDEducationPhysiotherapistAssess balance (gait) and mobilityStrength and balance trainingNeeds for physio. / rehab / restorative / assistive devicesTransfer adviceeducation
11 PREVENTIONCare Plans will be reviewed and updated, review toileting routines, transferring needs and mobilityPrevention strategies will also identify safety equipment such as mattresses on the floor, safety monitors/alarms for chair and bed, hip protectors.A multidisciplinary team meeting including the resident (if appropriate) and their family will be held following the assessment process to problem solve and draw an action plan for falls prevention.
12 Falls DrillsOn the scheduled date, a staff member will be assigned the role of “fallen person”. A case study scenario will be given to this staff member outlining their diagnosis, any injuries and the circumstances surrounding the “fall”.Once the team discovers the “fallen person”, they will proceed to care for them according to policy and procedure for falls management.The Falls Drill Report is completed by care team and submitted to the Director of Care. A debriefing meeting will be held following the drill to review the procedure and education as needed.
13 EVALUATION OF PROGRAM 2005 = total falls 799 2006 = total falls 526 2008 to present, focus on sustainability
14 Setting up a Falls Prevention Program Start small – set goalsIntroduce the initiative to the Leadership team, then departmental teams (get buy-in)Select one unit (the most interested team) to trial the programGet input and evaluate the program as you go, be open to new ideasEmbrace challengesCelebrate successesMaintain the commitment to be Resident Focused
15 Falls Committee In September 2009 we resumed our falls committee Consisting of RN’s, RPN’s, PSW’s, a Restorative Care Assistant, our Dietician, the Physiotherapist and the Safety & WellnessCo-ordinatorEach discipline brings a unique perspective on how to prevent fallsA “Frequent Fall Assessment” was created and are reviewed at meetings
16 Frequent Fall Assessment AgeDevice (transfer pole, trapeze)Aide (wheelchair, walker or cane)Medical ConditionsDementiaPain
17 Physiotherapy Assessment Tenetti and/or Berg ScoreIdentified GaitBalanceRange of MotionWeaknessTransfers
18 Medications Antianxiety Antidepressants Treatment of Osteoporosis (specifically Vitamin D)AnalgesicsWas there a medication change?
19 RestraintsReview the use of restraint with the staff, the resident, the family or SDM and the Occupational TherapistDid the restraint contribute to the fall?Can the restraint be removed?
20 Post Fall Assessment Review the Post Fall Assessment Environment Time LocationBehaviourFootwearVital Signs
21 Documentation Review the Chart What were they doing before the fall? Laboratory Results?Infections?Bath day?Were they ill?Any behaviours?
22 What interventions have already been tried? Were they effective? Pattern and CauseConsider all factors and opinions to identify any pattern and probable cause!What interventions have already been tried? Were they effective?
24 Review with The Resident and Their Family Discuss the Fall(s) and Review findingsPresent SuggestionsListenRespect their viewsEstablish a common goal!
25 Evaluate Evaluate effectiveness of individual cases at Falls Committee Monitor Falls Prevention Program with Quality and Risk Management Committee
26 ‘Frequent Faller’ case review Mr. and Mrs. W. are a very pleasant couple who have been married for 60 years. Each have their own room in a nursing home but have chosen to push both beds together in one room and use the other room down the hall, as a sitting area. Both residents have moderate dementia. Mr. W has noticeable weakness, walks stooped over, has difficulties balancing while standing and refuses to use his walker or even to grasp hand rails in hall.
27 Case Review ContinuedMr. W. has had 3 falls at different times of day, all in his room while his wife was assisting him to stand to go to the washroom. Both have call bells within reach, neither remember to use them.Mr. W. has a diagnosis of Osteoporosis and during his last fall, he obtained a compression fracture. The physician has prescribed Fentanyl Patch and Tylenol #3 prn.
28 Mr. And Mrs. WOne daughter, wants the residents separated, the other three children want their parents to remain together. Mr. and Mrs. W. don’t want to be separated. All agree to adjoining rooms which are not available at this time.
29 Pattern Interventions The pattern is easy in this case.For the past 60 years, Mrs. W. has cared for her husband.It would be unrealistic to expect that to change.Safety checks were initiatedBoth resident were reminded to call for assistanceMr W. has been co-operative with exercises suggested by PT
30 Some SuggestionsPharmacist review of treatment of Osteoporosis and Pain ControlOT referral for transferring device (if a pole is there he might use it)PT referral for strengthening exercise and safe transfersAdjoining room when availableReview and modify toileting scheduleContinue Safety Checks
31 Looking to the FutureThe committee will Identify those at risk using the “Falls RAP Key”Increase exercise through restorative care initiativesExplore risks and treatment of Osteoporosis