Transcript Best Practices in Care for Older Adults: Nursing Assistant Session 6

Best Practices in Care
for Older Adults:
Nursing Assistants
Session 6
ELDER Project
Fairfield University School of Nursing
Supported by
DHHS/HRSA/BHPr/Division of
Nursing Grant#D62HP06858
1
Session 6
Topics:
Falls
And Physical Restraint Reduction
For Older Adults
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DHHS/HRSA/BHPr/Division of
Nursing Grant#D62HP06858
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Topic 1: Falls
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DHHS/HRSA/BHPr/Division of
Nursing Grant#D62HP06858
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What is a fall at your
agency?
 If it is seen or not seen by someone who
works at the agency?
 What if you help them to the floor?
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Nursing Grant#D62HP06858
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Falls
 Falls are the number one cause of
accidental death in older adults
 For older adults, 1 out of 7 falls results in
a broken bone
 For those over age 75 who break a hip
because of a fall, half will die within one
year
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Nursing Grant#D62HP06858
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Who falls?
 About 1/3 of older adults living in
the community fall each year
 About 60-70% of nursing home
residents fall each year
 About 40% of nursing home
admissions are related to falls
and unsteady gait
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Nursing Grant#D62HP06858
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Good news….
 A fall does not always mean
injury for an older adult
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Risk factors that may lead
to falls for older adults:
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Memory changes
Medications
Changes in how they walk and balance
Use of canes and walkers
History of falls
Incontinence
Cluttered rooms
Changes in vision and hearing
Alcohol use
Low blood pressure
Depression
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What to tell the nurse
when a patient falls:
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What they were doing when they fell
What time of day they fell
If they felt different just before they fell
Where they fell
If anyone else saw them fall
What they patient says after the fall
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What can you do?
 Make sure eye glasses and hearing
aides are on and working
 Keep room well lit
 Remove any clutter from the room
 Make sure walkers and canes are nearby
 Report any changes you see to the nurse
 patient is unsteady and was not before
 patient complains of being dizzy
 blood pressure low
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Nursing Grant#D62HP06858
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What can you do?
 Take the patient to the bathroom every
one to two hours to avoid incontinence
 Talk to the older adult about falls, and
how to prevent them
 Make sure shoes fit well
 Use bed and chair alarms as needed
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Nursing Grant#D62HP06858
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Topic 2: Physical Restraint
Reduction
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Nursing Grant#D62HP06858
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Types of Physical
Restraints:
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Wrist and leg restraints
Wheelchair safety bars
Vest restraints
Mitts
Chairs with lapboards
Beds with siderails
Bedsheets
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Are we using restraints?
 What is your policy here?
 Goal is to use restraints as little as
possible
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Which Older Adults Are Most
At Risk For Being Restrained?
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Unsteady gait
History of falls
Severe illness (medical or psychiatric)
Memory changes
Recent surgery
Medical equipment in their way (IV lines)
People who wander
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Myths and Facts About
Physical Restraint Use
 Myth: The older adult should be
restrained because they are most
likely to fall and injure themselves
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Nursing Grant#D62HP06858
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FACT:
 Restraints do not lower the risks of
falls and serious injuries
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Nursing Grant#D62HP06858
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Myth:
 We use restraints because they
protect the patient from harm
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FACT:
 Physical restraints may cause harm
 Physical restraints places older adults
at risk for short and long term
physical, psychological, and
behavioral problems
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Myth:
 If we don’t restrain patients, and
they fall, the facility will be sued.
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Nursing Grant#D62HP06858
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FACT:
 There are laws that limit how and
when we can use restraints for
patients.
 JCAHO guidelines limit use of
restraints
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Nursing Grant#D62HP06858
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Myth:
 Older adults are not really bothered by
restraints
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FACT:
 Interviews with restrained older adults
have shown that they feel:
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Anger and fear
Embarrassment and sadness
Hopeless
Uncomfortable
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Myth:
 Low staffing causes the need for
restraints
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FACT:
 Many facilities have lowered or
stopped using restraints without
having more staff
 Restrained patients need more
time for care:
 Checking and taking off restraints
 Checking skin and how they are
doing
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What can happen to the
patient who has restraints ?
 They may:
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get very warm
have incontinence
get pressure ulcers
get pneumonia or other infections
lose their appetite
get constipation
get strangled by the restraint
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What is an Environmental
Restraint?
 Putting a person in a separate area
where they cannot get out
 Example: a room or a garden with gates
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What can you do?
 Use canes and walkers as needed
 Use bed or chair alarms
 Tell the nurse if they are having trouble
with unsteady gait
 Tell the nurse if a patient is acting out or
pulling at their tubes or dressings
 Use of service animals at some facilities
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What can you do?
 Tell the family how important their visits
are
 See if the family has any ideas about
why the patient may be acting out
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Nursing Grant#D62HP06858
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Bottom Line:
 It is best not to use restraints.
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Reference
The content covered in this
presentation is provided by the
John A. Hartford Foundation Institute
for Geriatric Nursing
(2001, 2003)
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Nursing Grant#D62HP06858
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Reference:
 Some of the material in this presentation
obtained and graciously shared by:
Mather LifeWays, 2003
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Nursing Grant#D62HP06858
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Power Point Presentation
Created by:
Kathy Saracino, MSN, RN, CWOCN
Fairfield University School of Nursing
ELDER Project Education Coordinator
Diana R. Mager, CRN, MSN
Fairfield University School of Nursing
ELDER Project Director
2007
Supported by
DHHS/HRSA/BHPr/Division of
Nursing Grant#D62HP06858
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