Improving Quality and Safety in the Workplace Starting

with Preventing FallsJessica Fordham, MSN, APRN, FNP-C

Mississippi University for WomenGraduate DNP Student

Nursing home residents account for about 20% of deaths from fall in the 65 and older age group

A 100 bed nursing home facility typically reports 100-200 falls a year

Between half and three-quarters of nursing residents fall each year which is double compared to older adults living in the community

Problem

About 1800 people living in nursing homes die from fall each year

10%-20% nursing home falls cause serious injuries

Disability, functional decline and reduced quality of life can be the results of a fall

Countless falls and resulting serious injuries are preventable

Problem

What is a Fall?

“Fall” refers to unintentionally coming to rest on the ground, floor, or other lower level but not as a result of an overwhelming external force

Fracture Head Injury Serious cut requiring suture Bruising Decline in function

Complication of Fall

Why do Falls Occur?

Poor nutrition Altered mental status Poor vision Medication side effects Acute or chronic diseases Altered walking and

balance Foot or shoe problems Environmental hazard

Substandard treatment Inadequate resident monitoring

Failure or delay of necessary care

Barriers to Fall Prevention

Minimum Data Set (MDS) is a n interdisciplinary assessment tool required by federal regulation for use in nursing home facilities Primary screening and assessment tool Measure health status and serve as a

comprehensive assessment for all residents Measures physical, clinical, psycho-social

functioning, and life care wishes

Guidance

American Medical Directors Association (AMDA)

Assess patient history of fall Is the patient at risk for falling

Medications Underlying conditions Functional status Neurological status Psychological factor Environmental factors (bed rails up, hand rails, hip pads)

Recommendations

Determine fall factors in risk assessment Quality assurance measures should be

implemented All residents should have an individualized care

plan Fall risk factors should be reviewed every 3

months

Recommendation

STEADI (Stopping Elderly Accidents, & Injuries) Tool kit

Created for healthcare providers who treat older adults who are at risk for fall

Contains Fall precaution algorithm, basic information about falls, case studies, conversation starters, standardized gait and balance assessment instructional video, educational handouts about fall prevention

Center for Disease Control

STEADI Algorithm

Timed Up and Go Test 30- Second Chair Stand Test 4 Stage Balance TestVideohttp://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/videos.html

Educational Videos

Timed Up and Go Test

Muscle strengthening and exercise classes Residential educational session concerning

proper use of gait aids and environmental safety Daily environmental safety inspection PI Tracking to Ensure Adequate Patient

Monitoring Staff Continuing Educational Modules which

includes medication management and environmental safety

Other Ways to Prevent Fall

GOAL

Promote the greatest level of independence ad mobility while simultaneously preventing falls and injuries.