Home Care

Falls Prevention and Management Program

September 2011

Overview

Definition of falls and injury

Falls Assessment

Strategies and interventions

Evaluating

Roles and Responsibilities

What is a Fall?

Staff were asked in June of 2011 to define what a “fall” was. Here are some of their answers:

• “Uncontrolled, accidental movement to the ground”

• “No longer in an upright position and is prone on the floor or sitting on the floor”

• “Person makes contact with the ground”• “Loss of balance, trip, stumble – may hit floor”• “Cooler weather!” (my personal favorite)

Definition of a Fall

A Fall is:

“An event that results in a person coming to rest inadvertently on the ground or floor or other lower level, with or without injury.”

Definition of an Injury

An Injury is:

“Any “disruption” in body integrity that was not present before the fall. This would include a scrape, bruise, bump, laceration, fracture, abrasion, etc.”

Consequences of Falls

• Fractures of hip, femur, humerus, wrist and rib• Soft tissue injuries• Hematoma

(subdural or other body area)• Transient confusion• Social/psychological consequences

(ex. loss of courage, independence, confidence and family reaction)

• Hospitalization• Death

Canadian Statistics

• Falls are the leading cause of overall injury cost in Canada

• They account for $6.2 billion or 31% of total costs of all injuries in a year. (Safer HealthCare Now!2011)

• Falls are primary cause of injury admissions to Canada’s acute care hospitals, accounting for 57% of all injury hospitalizations and more than 40% of all admissions to long term care.

Home Care Statistics

• From April 2011 to August 2011 there have been 10 recorded falls at Home Care

• These are clients who are over the age of 65 and are case managed

• These falls have been identified using the Confidential Occurrence Report

Strategies and Interventions

• Falls prevention is a Required Organizational Practice (ROP) of Accreditation Canada. All areas are required to implement a falls prevention strategy.

Strategies at Home Care

We are:

Implementing a Home Care Falls Committee/Program

Implementing a pilot project to reduce falls in areas 45 and 82 which includes the completion of a Home Safety Checklist

Educating all Home Care/SWADD staff about Falls

Home Care Falls Committee

Members:

Connie Fiorante RN co-chair

Lori Tulloch – Director

Glenda Popowich – Manager

Tamara McDermit – Manager

Linda Picot – Health Info Analyst

Brenda Federko – HHA

Tricia Murray – Office Assistant

Carol Hepting – OT

Cara Christian HHA co-chair

Lorna Kathol – Manager

Debbie Poncsak – Manager

Vicki Demerse – MDS Manager

Coleen Lundeen – RN

Linda Voss – LPN

Palliative sub-committee:

Bev Cross

Fall Risk Interventions

• Evaluate gait & balance

• Introduce exercise – reduces falls by 37%

• Medication Review – reduces falls by 21%

• Supplement Vit D – reduces falls by 43% (refer to article)

• Treat Vision impairment (i.e. cataracts)

• Manage Postural Hypotension

• Assess home for risk factors (Home Safety Checklist)*

• Gradual withdrawal of psychotropics – reduces falls by 66% (ex. hs sedation)

• Educate staff about falls*

* these are the interventions we are trying at Home Care

Home Care’s Fall Interventions

• Assess home for risk factors using the Home Safety Checklist – Pilot Area 45 & 82– Client must be a case managed client who triggered the

falls cap on initial needs assessment (in areas 45 & 82)

– Referral will be initiated for HHA or Therapies to complete the Home Safety Checklist

– Falls diary used to record falls for the year

– Annual needs assessment done

• Educate all Home Care/SWADD staff about Falls

Home Safety Checklist

• Takes approx 10 mins to complete

• Many questions about home environment

• Asterisked questions answered with a “yes” will require referral to OT/PT

• Qualitative question at the back “Is there anything else you would like to say about falling or about your environment?”

Evaluating

• Baseline data collected in area 45 and 82

• Falls diary will be collected every month and analyzed

• Comparison will be made between initial needs assessment and annual follow-up needs assessment

Roles and Responsibilities

• Support a safe environment

• Educate clients and family

• CEAC handout available “What to do if you have a fall”

Questions???