CHASING Z

ERO

FALL

S

5 2 0 0 I N T R O D U C T I O N T O G R A D U A T E N U R S I N G

S E P T E M B E R 1 9 , 2 0 1 2

S T A C I M A R C H A N D , B S N , R N

QUESTION

What characteristics and risk factors are associated with falls and what is best practice to identify adult patients at risk of falling while hospitalized?

OBJECTIVES

• Define falls• Discuss characteristics related to falls• Describe types of falls • Describe risk factors associated with

falls• Discuss 3 fall risk assessment tools• Describe best practice for fall

prevention

A FALL IS DEFINED AS:

An event whereby an individual unintentionally comes to rest on the ground or another lower level, with or without loss of consciousness.

PAY FOR PERFORMANCE

Centers for Medicare & Medicaid Services (CMS) stop payment for treatments associated with injuries from nosocomial falls.

Best Practice is to focus on improvement of fall rate over time within your own facility rather than comparing to other similar organizations.

MONITORING EFFECTIVENESS OF FALL REDUCTION PROGRAM

RN Skill Mix

For 10% increase in RN, the odds of falling decreased by 18.8%

CHARACTERISTICS RELATED TO FALLS

How falls risk varies according to ward (Nazarko, 2011)

TYPES OF FALLS

A N T I C I PAT E D

MedicationsEliminationBalance/gait Previous fallsImpulsiveConfusionPoor vision/hearing

U N A N T I C I PAT E D

CodeHeart AttackSeizureFaintingLow Blood SugarBradycardia

RISK FACTORS RELATING TO FALLSI N T R I N S I C

P A T I E N T R E L A T E D

Age related physiologic changes

Diseases Muscle Weakness Gait Disorders Mental Status Polypharmacy

E X T R I N S I C

E N V I R O N M E N T A L R E L A T E D

Room layout Location of room Equipment Clutter Lighting Wet floors Type of flooring

FALL REDUCTION PROGRAM

Identify patients at risk

Identify risk

factors

Treat risk

factors

FALL RISK ASSESSMENT TOOLS• History of falling• Secondary diagnosis• Ambulation aid• IV therapy• Gait• Mental status

Morse Fall Scale (MFS)

• History of falls• Mental status

Disorientation/agitation• Visual impairment• Toileting need• Transfer/mobility

St Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY)

• Confusion/disorientation/ impulsivity

• symptomatic depression• Altered elimination• Dizziness• Sex (male)• Prescribed anti-epileptic or

benzodiazepines• Get up and go testHendrich II Fall Risk Model (HFRM)

Fall risk score can be used to predict whether a patient is at risk of falling

FOR A FALL PREVENTION PROGRAM TO BE SUCCESSFUL EMPLOYEES MUST?

COMMUNICATE clearly with one another

SUMMARY

Risk from falling cannot be eliminated, however falls can be reduced by implementing an effective fall risk assessment tool. A culture of safety must be created in order to have positive outcomes and to improve quality of care.

REFERENCESGray-Miceli, D. (2007). Fall risk assessment for older adults: the Hendrich II Fall Risk

Model. Try This: Best Practices In Nursing Care To Older Adults, (8).

Kim, E., Mordiffi, S., Bee, W., Devi, K., & Evans, D. (2007). Evaluation of three fall-risk assessment tools in an acute care setting. Journal Of Advanced Nursing, 60(4), 427-435.

Nazarko, L. (2008). Falls part 4: prevention, assessment and intervention. British Journal Of Healthcare Assistants, 2(11), 535-539.

Nazarko, L. (2011). Falls: A momentary slip and a lifetime of consequences. British Journal Of Healthcare Assistants, 5(12), 604-607.

Stern C, Jayasekara R. Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic review. International Journal Of Evidence-Based Healthcare [serial online]. December 2009;7(4):243-249.

Swann, J. (2010). Simple ways to prevent falls. British Journal Of Healthcare Assistants, 4(4), 166-169.

Tideiksaar, R. (2009). Chapter 8: falls. In B. Bonder, V. Dal Bello-Haas, M. Wagner (Eds.) , Functional Performance in Older Adults (3rd Edition) (pp. 193-214). Philadelphia, Pennsylvania: F.A. Davis Company.

Titler, M. G., Shever, L. L., Kanak, M. F., Picone, D. M., & Qin, R. (2011). Factors associated with falls during hospitalization in an older adult population. Research & Theory For Nursing Practice, 25(2), 127-152.