Transcript Outcomes of an Interprofessional Fall Risk Assessment Program for

Outcomes of an Interprofessional Fall Risk
Assessment Program for Health Science
Students
Ann Ryan Haddad, Pharm.D.
Associate Professor of Pharmacy Practice
Director of Office of Interprofessional Scholarship, Service, and Education
Creighton University School of Pharmacy and Health Professions
Kelli L. Coover, Pharm.D., CGP
Associate Professor and Vice Chair of Pharmacy Practice
Assistant Director of Experiential Education
Creighton University School of Pharmacy & Health Professions
Overview

This program will highlight a longstanding interprofessional
fall risk assessment project that received the 2012 AACP
Student Community Engaged Service Award.

We will describe the collaboration with independent/assistedliving senior communities and the health professions students
involved.

Descriptions of screening tools used as well as student and
client outcomes will be discussed.

We will also examine other opportunities for interprofessional
collaboration with seniors.
Learning Objectives

Describe the interprofessional fall risk assessment
project.

Explain best practices established to replicate this
interprofessional experience in various senior care
settings.

Examine alternate scenarios where interprofessional
student teams provide screenings to clients.

Discuss changes in students’ perceptions of the
healthcare team.
Faculty Team

Dr. Ann Ryan Haddad (Pharmacy)

Dr. Kelli Coover (Pharmacy)

Dr. Lisa Black (Physical Therapy)

Dr. Judy Gale (Physical Therapy)

Dr. Kathy Flecky (Occupational Therapy)

Dr. Becky Davis (Nursing)

Yongyue Qi (Statistical Methods)

Ms. Kate Martens Stricklett and Ms. Ronna SearsFritz (Office of Interprofessional Scholarship,
Service & Education)
Fall Statistics

Each year, 2.5 million older people are treated in emergency
departments for fall injuries.

Over 700,000 patients a year are hospitalized because of a
fall injury, most often because of a head injury or hip fracture.

Each year at least 250,000 older people are hospitalized for
hip fractures.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query
and Reporting System (WISQARS) [online]. Accessed January 4, 2016.
Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall
and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients.
Calcif Tissue Int, 1999;65:183–7.
Background

Faculty preceptor had APPE students
conducting medication reviews for
residents at independent living facility.

Administrator expressed concern about
increasing fall rate and requested
medication reviews for those specific
residents.
Background

Concurrently, we had a pharmacy
student who had taken our Geriatric
Pharmacy elective and he wanted to
develop a fall risk toolkit.

He received a Paul Ambrose Scholar
Award to develop his project.
Background

Piloted interprofessional fall risk
assessments in Spring 2011

Offered annually

Independent living and assisted living
facilities
Description
• From 2012 – 2014, 188 students participated in
interprofessional fall risk assessment programs at 3 senior
living communities.
• Students were recruited to participate through our School’s
Office of Interprofessional Scholarship, Service and
Education.
• May be a required component of a course or healthcarerelated service hours
• Orientation
• Students attended an orientation
• Met their team
• Completed the Team Skills Scale pre-survey
• Team Skills Scale is a validated assessment tool
Hepburn K, Tsukuda R, Fasser C. Team skills scale. In Hyer K, et al (Eds.), Geriatric interdisciplinary
team training. The GITT Kit, 2nd edition. New York: John A. Hartford Foundation, Inc. 1996
Community Engagement CUe
Description

Day of Event: Students completed their disciplinespecific assessments.
 Nursing students completed interviews to collect
health history information
 Pharmacy students completed medication reviews or
medication fall risk scores
 Physical therapy students conducted Berg Balance
assessments.
 Occupational therapy students completed home
safety checklists.
Schedule for the Day
Students Doing Assessments
OT- Home Fall Prevention
Checklist
http://www.gericareonline.net/tools/eng/falls/attachments/Falls_Tool_23_H
ome_Safety_Checklist_CDC.pdf
http://www.gericareonline.net/tools/eng/falls/attachments/Falls_Tool_4_Ho
me_Safety_Questionnaire.pdf
Nursing 
Merged nursing screening questions with the “ASSESSMENT FOR INDEPENDENT LIVING”
(Service Coordinator Annual Tool)
–
–
–
–
–
Past medical history
Review of systems
Summary current medical history
Fall risk
Vitals
http://www.gericareonline.net/tools/eng/falls/attachments/Falls_Tool_4_Home_Safety_Questionnaire.pdf
PT – Berg Balance Scale
http://www.aahf.info/pdf/Berg_Balance_Scale.pdf
Pharmacy – Medication Action Plan
Pharmacy – Fall Risk Scoring
Beasley B, Patatanian E. Development and Implementation of a Pharmacy Fall Prevention Program. Hospital Pharmacy 2009. 44(12): 1095-1102
.
Description
• Day of Event continued:
• During lunch, student teams met to discuss findings and
then generated client-centered recommendations under the
supervision of licensed healthcare professionals.
• These recommendations were provided to the older adults
in fall risk report cards.
• Student teams brought the recommendations directly to the older
adults in their apartments
• Each participant received a folder with fall prevention information
• Facility staff received recommendations via care plans and
medication action plans to discuss with their senior
residents.
• Students then completed Team Skills Scale post-survey.
Sample Student
Recommendations

Occupational Therapy
– Add nightlights from bedroom to
bathroom
– Secure rugs with double-sided tape
or non-slip liners
– Remove clutter from walkways
– Avoid wearing only socks, wear
slippers with grippers
Sample Student
Recommendations

Physical Therapy
– Skilled PT evaluation for balance,
strength, and endurance to improve
gait and mobility skills and improve
functional status and independence
– Continue maintenance of balance
with exercise classes (Tai Chi and
walking)
Sample Student Recommendations

Nursing
–
Toileting plan for incontinence.
–
Follow up with doctor for bunions.
–
Address dentures and possible nutritional supplement for weight
loss.

Pharmacy
–
Dose diuretic in morning instead of at night.
–
Mirtazapine and trazodone may increase fall risk. Does resident
need both?
–
Currently takes furosemide, metoprolol, lisinopril, and amlodipine
for blood pressure control. These medications may have additive
effects on lowering blood pressure which may cause dizziness or
lightheadedness.
Resident Outcomes (Spring 2012)

45 residents assessed & received
recommendations from student teams

676 student recommendations to reduce
fall risk
•
306 Pharmacy
•
159 Occupational Therapy
•
132 Nursing
•
79 Physical Therapy
Pharmacy Student
Recommendations (2012)
Medication Risk Scores (2012)

The average number of medications taken
per resident was 6.76.
 The average Medication Risk Score was
6.99.
 A score of 6 or greater was recorded in 23 of
the 45 participating residents.
Referral to Healthcare Provider

Medication action plan recommendations - 29

Recheck blood pressure measurement - 15

Physical Therapy services - 27

Occupational Therapy services - 14

Visit an optometry provider for vision
assessment - 4
Resident Feedback

90% agreed/strongly agreed the program was of benefit to them.

73% would attend a future Fall Risk Assessment Program

90% would recommend the program to a friend

97% enjoyed interacting with the health science students

Regarding recommendations received from teams:

77% read the handouts for my own benefit

40% shared the information with the service
coordinator, friends, relatives, or neighbors

30% learned they had a risk factor for potential
falls

17% plan to see a physician or other health care
professional
Resident Feedback

Why did you choose to participate in the Fall Risk
Assessment Program?

–
Curious about Fall Risk health – 18
–
Service coordinator encouraged me to participate – 12
–
Convenient – 12
–
Free screenings – 9
–
Previously fell - 5
The Fall Risk Assessment program was beneficial to me.
–

Strongly agree/Agree – 26
Majority would recommend program to a friend/neighbor
Resident Feedback

I found the Fall Risk Assessment program valuable.

The students took time to explain so many new ideas to
me. Great job.

It should be given to older people who have fallen
before.

Most important so many things we overlook.

The students were helpful, full of knowledge in their
respective fields and will make terrific professionals on
their jobs.

It made me think more about protecting myself.
Student Comments

“I really enjoyed working with the students in all of the different professions.”

“I particularly enjoyed the experience of working on an interdisciplinary
team…..so it was neat to see how much everyone had to offer and contribute to
the plan for each patient.”

“We really do not get many interprofessional experiences in our normal
coursework, so this was great to be able to think on our feet and apply what we
know.”

“I really enjoyed working with pharmacy! As an OT, we work very closely with
PT and nursing, but rarely with pharmacy. It was great to hear their
perspective and better understand the heavy impact that medications have in
client goals and intervention outcomes.”
Results – Team Skills Scale
Challenges

Significant amount of time invested with planning
meetings

Student schedules don’t align

Faculty manpower and time

Unclear if recommendations were implemented
Best Practices


One year in advance, OISSE staff schedule facility site and event date.
–
Coordinate with students’ schedules (when they don’t have class or exams)
–
Students are recruited from courses requiring health service learning component
Three months before event, OISSE staff:
–
Onsite to give overview of screenings and recruit residents.
–
Recruit alternates
–
Planning session with faculty from all disciplines

OISSE staff regularly communicate with facility staff

Very detailed schedule provided to students/faculty.
–
Very efficient process (start at 8:30 and end at 2:30)
–
Students bring their lunches

Screening tools are simple to administer by students.

Improved fall risk report cards – more client centered
Best Practices

Eliminated time consuming elements:
– Handwrite report cards
– Don’t bring computers/printers (not all facilities have
reliable internet)

Rotate partner sites each year
Resident thank you notes – student teams write these onsite
before they leave
Student teams give the residents their fall report cards at
the end of the day before they leave
Developed a model to implement at other sites



Projects Described in the Literature
University
Project
Disciplines
Involved
Citation
South Carolina College of
Pharmacy, MUSC
Campus
Senior Mentor Geriatric
Medication Assessment
– incorporated into
required Clinical
Assessment Course
Pharmacy and Medical
students
AJPE 2014; 78(1) Article 14. Multiple
Interprofessional Education Activities Delivered
Longitudinally Within a Required Clinical Assessment
Course
University of
Saskatchewan
A quality improvement
exercise evaluating a
case about elderly
patients in transition
from acute care to
community care.
Pharmacy, Nursing,
Nutrition, and Physical
Therapy students
AJPE 2009; 73(4) Article 64. A Quality Improvement
Activity to Promote Interprofessional Collaboration
Among Health Professions Students
East Tennessee State
University
In-home comprehensive
medical and nutrition
assessments and
medication chart reviews
of high-risk older adults.
Pharmacy, Nursing,
Nurse Practitioner, and
Dietetic students
Gerontology & Geriatrics Education 2013; 34:43-59.
Students Delivering Health Care to a Vulnerable
Appalachian Population Through Interprofessional
Service-Learning
University of
Saskatchewan
Longitudinal Elderly
Person Shadowing –
student teams partner
with communitydwelling older adults
Pharmacy, Medical,
Physiotherapy, Nutrition,
Nursing, and Social Work
students
Gerontology & Geriatrics Education 2012; 302-323.
The Longitudinal Elderly Person Shadowing Program:
Outcomes From an Interprofessional Senior Partner
Mentoring Program.
Medical College of Ohio
Interdisciplinary team
health assessments with
rural, communitydwelling older adults.
Occupational Therapy,
Physical Therapy,
Physician Assistant, and
Public Health students
Occupational Therapy In Health Care 2002; 15:3-4,
13-34. The Rural Elderly Assessment Project: A
Model of Interdisciplinary Team Training
Student Community Engaged Service
Awards with Senior Focus
University
Project
Disciplines Involved
Year
University of the
Pacific Thomas J.
Long School of
Pharmacy and
Health Sciences
Mobile Medicare
Clinics
Pharmacy,
2014
Speech/Language
Pathology, Dental
Hygiene, Music
Therapy, Nurse
Practitioner students
University of
California, San
Francisco School of
Pharmacy
Partners in D
Program
Pharmacy students,
health professional
students
2012
Creighton University Interprofessional
Pharmacy, Nursing,
2012
School of Pharmacy Falls Prevention
Occupational
and Health
Program
Therapy, Physical
http://www.aacp.org/career/awards/Pages/studentcommunityengagedserviceawards.aspx
Professions
Therapy students
http://www.aacp.org/career/awards/Pages/studentcommunityengagedserviceawards.aspx
Closing Thoughts
Student
benefits of participating in the fall risk assessment program:
–
interact with older adults (real clients, not patient simulations)
–
become familiar with several health screening tools
–
collaborate interprofessionally
–
develop team skills
–
apply clinical skills before clinical rotations
–
safety net of faculty supervising and coaching
–
provide clinical recommendations
Seniors
received assessments not typically provided in an
independent/assisted living community.
It
is anticipated that interventions will be implemented to reduce fall risks and
allow these senior participants to continue living in this community.
Questions?
Please contact us at:
[email protected] or [email protected]