Presentation on theme: "Falls Prevention in Care Homes"— Presentation transcript:
1 Falls Prevention in Care Homes Inform delegates of the topic area – Falls prevention.
2 Aim To raise awareness of the causes and prevention of falls and fractures in older peopleliving in residential or nursing homes.Inform delegates of the aim - The principles of assessing and managing falls in Care Homes.
3 Outcomes By the end of the session delegates will be able to: Identify risk factors for fallsIdentify risk factors for OsteoporosisUnderstand that some risk factors can be modified or reduced and some are not modifiable at all.Inform delegates of the outcomes for the topic area.
4 Definition A fall is an unexpected event resulting in the Person coming to rest on the floor or otherlower level.It includes:Falling out of bedFalling off a chair or toiletFalling while walkingFalling downstairs.Aim – To define falls.Suggested activity:Read slideSuggested time 10 minutesRemember:StatisticsThe risk of falling rises with age:1 in 3 people between the ages of fall each year1 in 2 people over the age of 80 fall each year20% of falls in older people living in their own homes result in injuries requiring medical attention5-6% of these injuries are fracturesOlder people living in Care Homes are 3 times more likely to fall than older people living in the community because they are frailer.25% of falls in Care Homes result in serious injury and40% of hospital admissions from Care Homes follow a fallThe risk of a hip fracture for a resident with dementia is ten times higher than for an older person living in the communityThe effects of a fall on staff:Emergency action after a fall diverts staff from planned careCare to relieve injuries and anxiety from a fall increases workloadsComplaints about falls create a negative publicityLitigation may suggest a breach of the duty of careFalls are the highest cause of death for older people.
5 Risk factor Something associated with a condition or an event that makes it more likely tohappen.Aim – To understand risk factors.Suggested activity:Read slide and ask delegates to discuss other risk factors that you can think of e.g. high blood pressure being a risk factor for Stroke.Suggested time 5 minutes.
6 FallsFalls in older people are due to the interaction of their personal risk factors with their environment.Falls in older people are multi-factorial – not caused by one factor.Aim – Understanding falls.Suggested activity:Read slide and ask delegates to write down all the things that might make an older person more likely to fall.Suggested time 10 minutes.
7 Risk factors for falling PersonalEnvironmentalBehaviouralOf these, some areModifiable or reversibleNon-modifiableThe more risk factors a service user has, thegreater the risk of falling.Aim – Understanding risk factors in falling.Suggested activity:Get delegates into 3 groups and ask them to list on flip chart the risks under each heading highlighted on the slide.Personal:Anything associated with the person e.g. their medical conditions – both long term conditions (Stroke, Heart disease, Parkinson’s Disease, Diabetes, Arthritis & Dementia) and short term (infections), muscle strength, confidence, poor vision.Taking more than 4 prescribed medicines a day is a risk factor for falling. In addition, some drugs are more likely to cause a fall than others eg sedatives making a person drowsy and diuretics dropping the blood pressure.Environmental:Wet floors, poor lighting, trailing clothes, different/incorrect heights of furniture, wheels on bed/chairs, clutter!Behavioural:When a person chooses risk behaviour that is likely to result in a fall, eg going out in the snow and ice, climbing on furniture, drinking excessive alcoholSuggested time 10 minutes.
8 Reversible/modifiable Non-reversible Poor footwear Risk factorsReversible/modifiableNon-reversiblePoor footwearEnvironmental hazardsTaking lots of medicinesPostural Hypotension (Blood pressure dropping on standing)Muscle weaknessPoor balanceUnsteady walkingConfusion due to urine infectionMedical conditions e.g. StrokeVision e.g. blindnessLoss of feeling in feet and legs due to DiabetesConfusion due to DementiaAim – To understand risk factors.Suggested activity:Look at the 3 lists of risk factors made on flip chart and ask delegates to now consider which ones could be changed, removed or modified to reduce the risk of falling for that person. What else could you do in the Home to reduce the risk of falls?Suggested time 20 minutesRememberUse the factsheets to support learningMedicationBalance & PostureWalking & walking aidsFeet and footwearVision & hearing.
9 Bone Health 95% of hip fractures are caused by a fall A person with osteoporosis is at very high risk of breaking a bone if they fallOsteoporosis affects 1 in 2 women and 1 in 5 men over the age of 50Vertebral (spinal ) fractures occur without falling, are often unrecognised and very painfulBone density reduces with ageAim – Understanding bone health.This slide is animated. On your first click it will begin the animation and run automatically.Suggested activity:Read slide and ask delegates how many residents have had a fracture in the pastSuggested time 5 minutes.
10 What Osteoporosis looks like normalosteoproticAim – Understanding Osteoporosis.Suggested activity:Read slideSuggested time 5 minutesRemember:Osteoporosis is a silent disease, you don’t know you have it until you break a bone after a minor trip or fall.The risk of osteoporosis increases with age.Find out more information from The National Osteoporosis Society is the only charity that raises awareness of this disease, supports people suffering with it, and raises funds to pay for research into treatment for it.Their website has lots of informationThe booklet, ‘An introduction to Osteoporosis’ can be downloaded from the website or ordered via the telephone free of charge.
11 Preventing hip fractures Assess and reduce fall risk factors for every resident as much as possibleCheck all residents’ weight and think about their food intakeEncourage weight-bearing exercise, good posture and back careDiscourage smoking and excess alcohol intakeEncourage residents to sit outdoors in the summer for 20 minutesCheck that all residents are having Calcium & Vitamin D supplementation to help their bones and their balanceHip protectors can reduce the risk of a hip fracture if worn and correctly fitted.Aim – To understand how to prevent hip fracturesSuggested activity:Read slide and ask delegates to consider what could be done to reduce the risk of fracturesSuggested time 15 minutesRememberIf you can reduce the falls, you will reduce the risk of fracture for your residents.Residents who are thin are more likely to fracture if they fall, its important to check their weight regularly and inform the GP of weight loss. You may wish to ask for a referral to a Dietician.Bones need weight bearing exercise, residents who sit or lie down for much of their day are more at risk of Osteoporosis.Encourage good posture and think about good back care – for staff as well as residents.Sitting out in the garden (not in full sun) for 20 minutes a day between May & September will help to make Vitamin D which we need for our balance as well as our bones.There is evidence that older people in Care Homes are deficient in Vitamin D; a supplement of Calcium & Vitamin D is recommended for all mobile residents.Hip protectors can reduce the risk of a hip fracture but must be correctly measured and fitted for an individual resident. See the Hip Protector information factsheet.
12 How can we reduce falls?Evidence suggests that the number of falls andinjuries can be reduced when:an older person receives an individual assessment of their risk factorstheir reversible risk factors are identified and reducedtheir care plan shows action taken to reduce fall and fracture riskall staff are aware of residents likely to falleveryone works together – falls need team work!Aim – To understand how to prevent hip fracturesSuggested activity:Read slide and ask delegates to identify a service user who has had falls, look at their risk factors, care plan and check if there is anything more that can be done to reduce the risk of a fall.Suggested time 20 minutesRememberReducing falls in a Care Home is ‘everybody’s business!’All Care Home residents are at high risk of fallingIt is not enough to complete a falls risk assessment and do nothing elseLook out for reversible risk factors e.g. a resident who is unusually confused due to a urine infectionReport it! Act on it! You could ask for a GP review.Ensure all staff are aware, encourage fluids.In your Home is there a policy that ensures residents have:Falls risk assessment on admission, after 3 months and after a fallNutritional assessmentMedication reviewContinence assessmentChiropody/footwearEnvironmental risk assessment – bedroom, bathroom, communal areasWalking aid checks.
13 Comfort checksA method of providing care to a resident on a regular basisA comfort check would include:Asking how the person is, if they have any painAsking if they would like to go to the toilet or for a walkOffering a drinkChecking they have good footwear onChecking the area around them for trip/fall hazardsEnsuring that their walking aid/glasses/call bell are close at handTelling the resident that you will be back again to see how they are in an hour.Aim – To understand how comfort checks can support the prevention of fallsSuggested activity:Read slideSuggested time 5 minutesRememberFalls can be reduced by regularly checking on residents. Many residents will fall while trying to go to the toilet unaided.
14 Posture and Seating Good posture is important for residents Poor posture can cause:Pressure ulcersPain in muscles and jointsRisk of falling out of the chairDifficulty eating, talking, breathingPoor balance and higher risk of falls when standingAim – To understand how comfort checks can support the prevention of fallsSuggested activity:Read slideSuggested time 5 minutesRememberSitting for too long in a poor position can cause skin to breakdown, it is important to encourage residents to move every minutes.Sitting with rounded shoulders and a flexed (curved) spine will make it difficult to straighten up to drink properly. Breathing will be more difficult as the lungs have little room for expansion, and indigestion is more likely as the stomach is compressed into a smaller space.
15 Top tips Change position often – stand up every 2 hours Rest on the bed for an hour after lunch, allows joints and muscles to stretch and takes weight off the bottomWhen sitting, ensure feet are on the ground or footrestHip, knee and ankle should be at 90°Encourage residents to sit symmetrically, not leaning to one sideIf the chair is too low, raise the height through the legs, rather than adding extra cushionsIf a resident can’t move well in a chair, help them to stand up and sit down againEncourage activity and mobilityAim – Top tips to support the prevention of fallsSuggested activity:Read slide and ask delegates what they can do to improve service users comfort and postureSuggested time 10 minutes.
16 Top tips for maintaining mobility Regular (daily if possible) exerciseEncourage residents to walk whenever possible, check walking aids are clean and in good condition and the right sizeEnsure you use the correct techniques for assisting residents to stand up and walkingEnsure (as far as possible) that all residents have good, safe footwear, light shoes are better than loose slippers.Aim – Top tips to support the prevention of fallsSuggested activity:Read slide and ask delegates what they can do to maintain mobilitySuggested time 10 minutesRememberDo you run exercise sessions? Do you have an activity coordinator who leads activities? If not, could you start an exercise session?Hampshire County Council leads training sessions on exercise – Better Balance for Life. Contact Sophie Jevons on Walking aids:These need to be checked and cleaned regularly for safety and should be labelled with the resident’s name.How to assist a resident to stand up from a chair:encourage the resident to wriggle forwards to the front of the chair,both hands on the arms of the chairlean forwardspush with handsstraighten kneesplace hands on the framestaff hand on residents back to assist with forward movement.Ensure staff do not put their arms under the residents’ shoulder – shoulders can be dislocated in this way.FootwearDiscourage loose slippers and slingback, open toe sandals. Thin soles, good support and flat or low heels are more helpful for balance and walking.Good footwear can be provided from various catalogues eg Cosytoes and DBshoes.
17 Bedrail useFalling out of bed can cause a head injury or fractured hipBedrails are not to be used to prevent residents getting out of bed i.e. as a restraintDo not use for residents who are confused and mobile enough to climb over or round themThere is a risk of limbs becoming trapped in bedrails, so bumpers/covers should be usedAim – Understand the use of bedrails to support the prevention of fallsSuggested activity:Read slide and ask delegates discuss decisions using the flowchart handoutSuggested time 10 minutesRememberIf available, an ultra low bed can be used to reduce the risk of injury from a fall out of bedSensors and alarms could be used to monitor residents at risk of falls.
18 Action following a fall: 1 Most falls in Care Homes are un-witnessedAssume a head injury may have been sustained unless proven otherwiseRefer to post fall protocolConsider whether the resident needs to be moved – ‘don’t add insult to injury’Head injury observations for un-witnessed falls as well as when there is clear evidence of a head injuryAim – Understand the actions requiredSuggested activity:Read slide and ask delegates to discuss the procedure for managing a service user who has fallen.Consider - Is it written clearly and displayed where all staff can read it?If appropriate, ensure staff are competent in taking head injury observations.Suggested time 20 minutesRememberMost falls in Care Homes are un-witnessed so it is important to assess carefully when finding a resident on the floor.The person may have hit their head.The person may have a hip or spinal fracture which will become more serious if they are moved or hoisted.
19 Action following a fall: 2 Complete accident/incident bookInform the GPInform the relativesComplete the resident’s falls registerUpdate the falls care planEnsure all staff are aware of the fallAim – Understand the actions requiredSuggested activity:Read slide and ask delegates to if they use an individual falls register for each resident?Discuss what information is needed when writing a report after a fall using the Reporting Falls prompt sheet.Include as much information as possible – just writing “found on floor” is not helpful when trying to prevent another fall for that residentSuggested time 20 minutes.
20 Days since last fall ___ days 1234567891011121314151617181920212223242526Days since last fall2728___ days293031Aim – to understand the safety cross – visual measurement toolSuggested activity:Using the slide explain the safety cross principlesGreen = 0 falls Red = falls with number of incidentsThe Safety Cross is a good way of ensuring all staff are aware of which residents are falling and how often. The goal is to have each month coloured ingreen and the number in the bottom left hand corner of the page showing an increasing length of time since the last fall.Other ways of recording fallsGet a floor plan of the Home and stick a coloured dot on the place where there is a resident fall. This shows up ‘hot spots’ which might be connected with flooring or lighting.Use a Clock face to identify the times of day that falls are happening. You could review staffing levels or activity at those times.Suggested time 10 minutes.
21 To prevent falls you need to Carry out regular audit by managers/senior staff of fall numbers, times, locations, injuriesFeedback to all staff about fall ratesHave good handover and communication between staffEnsure there are regular falls training updates and induction for new staffInvolve residents and families in falls prevention measures and educationAim – to find falls championsSuggested activity:Read slide and ask delegates if they are willing to be ‘falls champions’. They can help to raise awareness in the Home.Encourage them to accompany you to the PaCT conferences for updates.Ideas you may like to try:Join in with National Falls Awareness Week, run by Age UK for 1 week in June each year. Details can be found on the website:Put some posters up in the Home, invite families to join in activities to raise awareness of falls e.g. exercise session,Use other dates e.g. National Osteoporosis month (June) to organise events to raise awareness.Suggested time 10 minutes.