Transcript FileNewTemplate - Cynosure Health

The ABCS of Fall Injury
Prevention
A new look at preventing harm
from falls
Defining Falls with Injury
All documented falls with an
injury level of minor or greater
– Minor indicates those injuries
requiring a simple
intervention.
Types of Falls
Accidental Fall
• Tripping
• Environmental issue
Anticipated
Physiological Fall
• Risk Assessed
Unanticipated
Physiological Fall
• Unexpected loss of
consciousness
Behavioral Fall
• Intentional
Where to focus?
• All Falls?
• Falls with Injury?
• What falls can be
prevented?
• What injuries can be
prevented?
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Recommended Focus
• Preventable Falls
– Accidental Falls
– Anticipated
Physiological Falls
• Prevent injury
Cost of an Injurious Fall
• Human Cost
• Monetary Cost
– Pain
– Injury
– Fear of falling leading to
decreased mobility
– Loss of independence
– Loss of life
Cost reference: Wu, S., Keeler, E., Rubenstein, L., Maglione, M.A., &
Shekelle, P.G. (2010). A cost-effectiveness analysis of a proposed
national falls prevention program. Clinical Geriatric Medicine. 26.
751-766.
– Average $11,250
• $3,500-$27,000
– Law suits
Did you know?
Falls are the leading cause of death due to injury age 65 and older
• Risk Factors:
–
–
–
–
–
Recent fall
muscle weakness
behavioral disturbance
agitation, confusion
urinary incontinence and
frequency
– prescription of “culprit
drugs”
– postural hypotension or
syncope
Other things we know about
falls….
• 3-20% of inpatients fall at least
once
• 30% to 51% result in injury
– 6-44% of these result in serious
injury that could lead to death
• Fracture
• Subdural hematoma
• Excessive Bleeding
Oliver D, Healey F, Haines T. Preventing falls and fall-related injuries in
hospitals. Clinics in Geriatric Medicine. 2010;26(4):645-692.
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Why is reducing harm from falls
so difficult?
• What are the challenges?
• Why is it so difficult to achieve and sustain
ZERO?
Brainstorm your ideas
around challenges in
preventing falls
Fall Injury Prevention Failures
• Typical failures associated with patient assessment include the
following:
– Failure to recognize the limitations of the falls risk screening tools
– Lack of a standardized or reliable process for comprehensive fall risk
assessment
– Lack of identification of patients at increased risk for a fall-related
injury
– Lack of expertise in administering the assessment after positive risk
screening
– Late administration of multifactorial and interdisciplinary assessment
– Lack of procedure for or time to consistently reassess change in
patient condition
– Lack of clarity in expectations regarding patient assessment
– Failure to intervene quickly and link interventions to specific assessed
risk factors
– Failure to reassess risk during patients’ entire hospital stay
Risk for fall
• Major focus for hospitals
• Everyone is at risk – dilutes the significance
• New approach:
Who is at risk for INJURY?
Look at both
Injury
Risk
Fall
Risk
Interventions
based upon
fall risk and
injury risk
Identify Patients at Risk for Injury
ABC’S:
A = Age >85
B = Bone (fracture risk or
history)
C = anti Coagulation or
bleeding disorder
S = Surgery during current
episode of care
Age: > 85 years old
• Sensory Deficits
– Visual
– Hearing
– Sensation / Neuropathy
• Orthostatic Hypotension
• Mental Status changes
• Weakness due to immobility
Age: > 85 years old
• Teach Back Strategies
• Assistive Devices
– Sensory – glasses / hearing aid
– Mobility
• Floor Mats
• Hip protectors if fracture risk
• Height Adjustable Beds (low
when resting only, raise up bed
for transfer)
• Safe Exit Side if patient is
independent
• Medication Review
– Remove Ambien from order sets
– Pharmacist review for culprit
medications
Bones
• Osteoporosis Diagnosis
• History of Fracture
• Osteoporosis Risk Factors
–
–
–
–
Smoking
Steroid use
Alcohol use
Chemo therapy
Bones
•
•
•
•
•
Hip Protectors
Low Beds
Floor Mats
Evaluation of Osteoporosis
Vitamin D / Calcium
Coagulation/Bleeds
• Patients on
Anticoagulants
• Platelet disorder
• History of excessive
bleeding
Coagulation/Bleeds
•
•
•
•
•
Evaluate Use of Anticoagulation
Patient Education / Teach back
Helmets – TBI and Anticoagulants
Wheelchair Users: Anti-tippers
Incorporate risk for internal bleeding in post fall
assessment and interventions, i.e. CT scan
Coagulation/Bleeds
• Teach patients and
families about the risk
for bleeding with a fall
– In the Hospital
– In the Community
http://www.patientsafety.va.gov/docs/fallsToolkit/EducationBrochure_Anticoagulants-102407.pdf
Surgical Patients
• Surgical procedure
during current episode
of care
• Lower extremity
amputation
• Thoracic / Abdominal
surgery
Surgical Patients
• Pre-op Education / Teach Back:
– Call, Don’t Fall
– Call Lights
• Post-op Education / Teach Back
• Pain Medication:
– Offer elimination prior to pain
medication
• Increase Frequency of
Rounds
Injury Prevention Interventions
• Hip Protectors
• Helmets
• Vit D and Calcium
• Floor Mats
– Osteoporosis
• Close monitoring
• Address sensory deficits
– Glasses, hearing aids, lighting
• Low Beds
• Patient Family Engagement
–
–
–
–
Teach back
Pre op and post op Teaching
Bedside handoffs
Family monitoring
Best Practices in Preventing Falls
• Patient Family Engagement
–
–
–
–
–
Pre op teaching
Whiteboards
Contracts
Teach back
Bedside Handoff
• Toileting supervision
– No one toilets alone
– Safety Trumps Privacy
– Scripting
• Proactive Mobility Programs
– Ambulation
– PT/OT
• Purposeful Rounding
– Possessions
– Pathway
– Potty
• Communication
– Safety Huddles
– Post Fall Huddles
– Weekly Fall Debriefs
• Medication Management
– Remove Ambien from order
sets
– Pharmacist review for specific
populations
Choosing Protective Equipment and
Technology
• Engage staff and patients in selecting
equipment to test
• Test equipment on a small scale
• Keep equipment accessible, and stored safely
when not in use
• Avoid heavy reliance on bed and chair alarms
to prevent alarm fatigue
Bedside Mats – Fall Cushions
CARE Pad
bedside
fall cushion
NOA Floor Mat
Roll-on bedside mat
Tri-fold bedside mat
Posey Floor Cushion
Soft Fall bedside mat
Hip Protectors – Examples
Safehip
CuraMedica
KPH
HipGuard
HIPS
Assistive technology for safe mobility-Bed & Chair
Monitors
AirPro Alarm
Economy Pad Alarm
Locator Alarm
Floor Mat
Monitor
Keep Safe
Bed & Chair Alarm
QualCare Alarm
Chair Sentry
Safe-T Mate Alarmed
Seatbelt
Key Resources
• HRET improvement guide http://hret-hen.org/injuriesfrom-falls-and-immobility
• AHRQ Preventing Falls Toolkit
http://www.ahrq.gov/professionals/systems/hospital/f
allpxtoolkit/fallpxtoolkit.pdf
• VA National Center for Patient Safety: Fall Tool Kit
http://www.patientsafety.va.gov/professionals/onthejo
b/falls.asp
• IHI: How to Guide on Injuries from Falls
http://www.ihi.org/resources/Pages/Tools/TCABHowToG
uideReducingPatientInjuriesfromFalls.aspx
Contact Information
Jackie Conrad RN, BSN, MBA
Improvement Advisor
Cynosure Health
708-420-1130
[email protected]