Falls Prevention/Injury Reduction Getting Started Kit – 2nd Edition – What’s New in Fall Best Practices?

www.saferhealthcarenow.ca

Presenters:

Dr. Fabio Feldman

Dr. Vicky Scott

Hélène Riverin

Brenda Dusek

Falls Prevention/Injury Reduction Getting Started Kit – 2nd Edition

What’s New in Fall Best Practices?


Date: Tuesday June 25, 2013

Time 9:00 a.m. – 10:00 a.m. PDT

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Falls Prevention/Injury Reduction Getting

Started Kit

2nd Edition

What’s New in Fall Best Practices

Hosts

Brenda Dusek

RNAO iaBPG Program

Manager

Falls Intervention Lead

National Call Host

Gina Peck

Administrative Assistant/Office

Coordinator, Atlantic Canada

Canadian Patient Safety Institute

Technical Support

Hélène Riverin,

Safety and Improvement Advisor

Quebec

French Support


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Falls Prevention/Injury Reduction

Intervention Model – What’s New?


Dr. Fabio Feldman

Presenters

Dr. Vicky Scott

Hélène

Riverin

Brenda

Dusek


A Fall?

An event that results in a person coming to rest inadvertently on the

ground or floor or other lower level, with or without injury – which

includes:

•Unwitnessed fall = where the client is able/unable to explain the

events and there is evidence to support that a fall has occurred.

What’s New?

Definition Adjustments


A Near Fall?

A slip, trip, stumble or loss of balance such that the individual

starts to fall but is either able to recover (witnessed or

unwitnessed) and remains upright because their balance recovery

mechanisms were activated and/or caught by staff/other persons,

or they were eased to the ground or floor or other lower level, by

staff/other persons e.g. could not stop or prevent falling to the

ground, floor or lower surface.

What’s New?



What is a Fall Injury?

An injury that results from a fall, which may or may not require

treatment. The injury can be temporary or permanent and vary in

the severity

of harm.

What’s New?



SAFE ENVIRONMENT, ASSIST WITH MOBILITY, FALL RISK REDUCTION, ENGAGE CLIENT AND FAMILY

• Assess all clients on admission, on a regular schedule, and following change of status and following a fall

MULTIFACTORIAL

RISK ASSESSMENT • Communicate the results

of the fall risk assessment to the client and family, and healthcare team

• Educate all staff on fall prevention/injury reduction strategies and on specific fall risk factors

• Educate all clients who have been assessed at high risk for a fall and fall-related injury and their family regarding fall risk status

COMMUNICATION AND EDUCATION ABOUT FALL RISK

IMPLEMENT INTERVENTIONS FOR THOSE AT

RISK OF FALLING

• Implement individualized interventions targeted to the client-specific risk factors.

• Modify the environment and provide personal protective devices

INDIVIDUALIZE INTERVENTIONS FOR THOSE AT HIGH RISK OF A FALL-RELATED

INJURY

•Client Level:

•Create an individualized

care plan based on identified

risk factors

•Organizational Level:

•Develop policies for fall

prevention/injury reduction

management, that includes:

HCP and organization role

responsibilities for fall risk

assessment

•Develop an approach for

regular safety checks

•Investigate falls, near falls

(includes unwitnessed) to

determine contributing factors

Prevention: Universal Fall Precautions (SAFE)

Falls Prevention/Injury Reduction Intervention Model

What’s New?


Prevention: Universal Fall Precautions (SAFE)


Multifactorial Risk Assessment – What’s New? Risk Factors for Falling:

Use of adapted BBSE MODEL of fall-related risk factors:

Scott,, V. (2012). Fall Prevention Programming: Designing, implementing and

evaluating Fall Prevention Programs for older Adults. Raleigh, North Carolina: Lulu

Publishing.

What’s New

Increased focus on:

(Intrinsic)

Risk Factors Biological Pertain to the human body

Multiple factors increases fall

risk

advancing age

chronic disabilities

visual impairment

inadequate hydration and/or

nutrition

(Extrinsic)

Risk Factors Behavioural Understanding the

association between risk

factors and a person’s

actions, emotions & that

increase the risk

multiple medications

Inadequate hydration/nutrition

Social and Economic Conditions/circumstances that

permit/shape health:

social isolation

poor support networks

socially deprived populations

culture and ethnicity

low income (below $15,000)

living conditions e.g. supports

income impacts on food choices

Environmental associated hazards within our

physical surroundings

home hazards

support aids: balance, visual etc

accessibility


Fall Risk Factor

Assessment Tools – What’s NEW?

More explanation of categories and classifications for fall

risk assessment tools:

Categories:

1. Multifactorial tools

2. Functional mobility tools

3. Environmental Hazard Checklists

Classifications:

•Quick Screening

•Comprehensive


Screening Parameter

Screening Tool and Approach Chart- Figure 5

Screening parameter

Appropriate Screening Tool(s) and Approach

Screen for physical and

functional status (*See

examples of tools in

Appendix D*)

Some examples of tools that could be used to screen for

physical or functional status include

Quick Screen:

*Timed Up and Go

Sit-to-Stand

Tandem Stance

Functional Reach

Other Assessment tools

Scott Fall Risk Screen Tool (SFRS)©

*Berg Balance Scale

Fullerton Advanced Balance (FAB) scale

Stop walking when talking

The BESTest (balance evaluation system test

* Tinetti Performance Oriented Mobility Assessment

(POMA)

Walking speed


Screening parameter Appropriate Screening Tool(s) and Approach

Screen for cognitive

impairment

Examples of tools that could be used to screen for cognitive

impairment include:

Mini-Mental Status Exam (MMSE)

Confusion Assessment Method (CAM)

Mini Cog available at

Montreal Cognitive Assessment (MoCA)

Screen for osteoporosis Osteoporosis screening and intervention are imperative to

prevent fractures in all men and women over the age of 50

years. When risk factors for osteoporosis – consider BMD

testing Further facts and statistics are available at

http://www.osteoporosis.ca/index.php/ci_id/8867/la_id/1.htm

Fracture Risk Assessment Tools:

The Canadian WHO Fracture Risk Assessment Tool

(FRAX); and

Canadian Association of Radiologist and Osteoporosis

Canada (CAROC)

Both can be accessed at

http://www.osteoporosis.ca/multimedia/tools.html.

Screening Parameter

Screening Tool and Approach Chart – Figure 5

http://www.osteoporosis.ca/index.php/ci_id/8867/la_id/1.htm

http://www.osteoporosis.ca/multimedia/tools.html


Screening parameter Appropriate Screening Tool(s) and Approach Screen for hearing and visual acuity Vision screening tools provide a quick and easy approach to vision

assessment to determine if visual impairment.

•A Vision Screening Kit available at: Misericordia Health Centre which

focuses on Falls Prevention & Vision screening @

http://www.misericordia.mb.ca/AboutUs/VisionScreening.html

The Centre for Eye Research Australia has examples of vision

screening tools: http://www.cera.org.au/our-work/resources/vision-

screening-tools.

Example kit contents:

Vision Screening Booklet

Pinhole

E Card Booklet (Near and Distance visual acuity)

Matching Card

E Card Tests: o Distance –6/6, 6/12, 6/18, 6/60, 3/60 o Near – N8, N20, N48

Screen for malnutrition (*See

examples of tools in Appendix E*)

and dehydration

Assess current nutrition risk with valid tools such as:

*MST, *SCREEN© or *MNA-SF®.

Several recommendations to improve food intake can be made based

on screening tool risk factors;

Refer high risk clients who require a full

assessment to a dietitian.

Screening Parameter

Screening Tool and Approach Chart –

Figure 5




http://www.cera.org.au/our-work/resources/vision-screening-tools








EXAMPLE: Long Term Care,

CSSS de la Vieille-Capitale;

2013.

A logo is used according to the score

•Client screened with the Scott Fall Risk Screening Tool

•All identified risks addressed

•Score above 12 on the screening tool = high risk of falling and unsafe

ambulation

•Surveillance increased

•Identifier used

Communication of Fall Risk -


Implement Interventions for Those at Risk for Falling

Canadian Fall Prevention Curriculum Model - BEEEACH

Reproduced with permission Vicky Scott, PhD; 2013.


Interventions Known to Modify Fall Risk Factors- Figure 7

Risk Factors for Falls Interventions known to modify risk based on fall risk factor

Age, over 80 years of age

Fear of falling Encourage the individual to verbalize feelings.

Strengthen self-efficacy related to transfers and ambulation by

providing verbal encouragement about capabilities and

demonstrating to the individual their ability to perform safely.

History of previous falls or near

falls

Identify the client as being at risk for a fall or near fall reoccurrence.

Communicate risk by use of a visual identifier.

Address causes of falls based on past fall assessment.

Further assess physical function, balance etc.

Acute illness, such as UTI,

pneumonia, etc.

Treat acute condition and re-evaluate risk factors. Increase

observation- e.g. nurse rounding.

Chronic illness and or conditions,

such as stroke

(balance/mobility/limb paralysis),

hypotension, postural

(orthostatic) or Post-prandial

hypotension, depression, etc.

Treat chronic condition and re-evaluate risk factors.

Educate client on the risks associated with condition e.g. change in

posture leading to postural orthostatic hypotension.


Interventions Known to Modify Fall Risk Factors- Figure 7

Medication reviews should include review of the client’s medical

conditions/diagnoses/health problems and medications prescribed which includes:

1. Use of:

•non-prescription medications

•natural health products

2. Description of how the client is actually taking the drug products

3. Identification of any:

•condition not treated or undertreated

•drug product taken without an indication

•drug being misused (e.g. excessive duration or dose)

•high-risk medication being used with the potential to increase the risk of

falling (See Appendix B)

4. Treatment for bone health including over the counter Calcium and

Vitamin D (Prevention and Treatment of Osteoporosis

Section )


Define the Problem

Identify Fall Risk Factors

Examine Fall Prevention/Injury Reduction

Best Practices

Implement the Fall Prevention/Injury Reduction

Program

Evaluate Fall Prevention/Injury Reduction

Program

Adapted: A Public Health Approach to Fall Prevention Among Older Persons in Canada Model

Figure 8

Public Health Approach Model Adapted with permission, Elsevier Limited, The Boulevard, Langford Lane, Kidlington,Oxford,

OX5 1GB,UK ; Authors: Vicky Scott, Brandon Wagar, Alison Sum, Sarah Metcalfe, Lori Wagar; 2013.

Organization Strategies - Implementation


Restraint Use

Home Health Care

Policy and Procedures – Restraint Use


Individualize Interventions

for

Those at High Risk of a Fall-Related Injury

•Figure 9 Risk Fall, Hip Fracture

and Severity of fall Injury: This

chart reviews factors that increase

risk for fall or hip fracture or

factors that potentiate severity of

injury

•Figure 10 Chart focus on

Interventions that prevent or

minimize risk/ severity of injury

•Additional focus in this section on

Osteoporosis – pharmacological

interventions & exercise, injury

site protection



for


•Additional focus

in this section

on:

Osteoporosis –

pharmacological

interventions



for


•Additional focus in this section on

Exercise



for


•Additional focus

in this section on

Hip Protectors


New Indicators There are now seven measures for Acute Care and 8 Measures for Long Term Care:

NEW: 8. (# 8 Long Term Care but # 7 for Acute Care):

Injury Rate related to falls (Fall Related INJURY Rate) per 1000

patient/resident days (Outcome Measure)

Measuring the Success of Fall

Prevention/Injury Reduction Programs

Total Number of Injuries (Fall related INJURY) related to falls reported this

Month

Total Number of Patient/Resident Days on the Facility or Unit within the

Facility this month

x 1000 = Injury Rate related to falls (Falls Related Injury Rate) per 1000

Patient/Resident Days


New Indicators There are now six measures for Home Health Care:

NEW: 6. (NEW) Restraint Use (Balancing Measure)

Measuring the Success of Fall

Prevention/Injury Reduction Programs

Total Number of Clients Receiving Home Health Care with Restraints

Applied

Total Number of Clients Receiving Home Health Care in the same

time period

x 100 = Percentage of Clients with Restraints


GSK – 2nd Edition available at:

http://www.saferhealthcarenow.ca/EN/Interventions/Falls/Pages/

resources.aspx

http://www.saferhealthcarenow.ca/EN/Interventions/Falls/Pages/resources.aspx











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Special Thank You

SHN Falls Intervention Faculty 2013

Cheryl Sadowski, PhD

Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta

Donna Davis

Co-chair, Patients for Patient Safety Canada, Carievale, Saskatchewan

Brenda Dusek RN, BN, MN

Program Manager, IABPG, RNAO, Toronto, Ontario

Fabio Feldman, PhD

Manager, Seniors Fall and Injury Prevention, Fraser Health Authority

Kimberly Fraser, PhD

Assistant Professor, Faculty of Nursing, University of Alberta, Edmonton, AB

Nadine Glenn

CPSI, SIA SHN

Heather Keller RD, PhD

Schlegel Research Chair Nutrition & Aging Department of Kinesiology, University of Waterloo, Ontario

Anne MacLaurin, RN, BSCN, MN

CPSI, Project Manager, SHN


Special Thank You


Susan McAlpine, B.Sc.P.T.

Physiotherapist, CSSS d’Argenteuil, Lachute, Quebec

Coordinator of Clinical Education, Physical Rehabilitation Program, Dawson College, Montreal, QC

Heather McConnell

Associate Director, IABPG, RNAO

Alexandra Papaioannou, BScN, MSc, CIHR, MD

Eli Lilly Chair Professor of Medicine McMaster University, Hamilton Health Sciences, Ontario

Vanina Dal Bello-Haas, PT, PhD

School of Rehabilitation Science, McMaster University, Hamilton, Ontario

Rayma O’Donnell

Director of Care Services, York Manor, Fredericton, New Brunswick

Carla Marie Purcell, RN, BScN,

Clinical Nurse Educator, Capital Health, Halifax, Nova Scotia


Special Thank You


Helene Riverin

Conseillère clinicienne en physiothérapie, CSSS de la Vieille-Capitale, Quebec

Vicky Scott, PhD

Senior Advisor on Fall & Injury Prevention, British Columbia Injury Research &

Prevention Unit and Ministry of Health Services, Victoria, BC

Laura M. Wagner, RN, PhD,

Adjunct Scientist, Rotman Research Institute, Baycrest, Toronto, ON


• Special Thanks to:

– Falls Prevention/Injury

Reduction Intervention

Faculty

– Guest Speakers

– Technical Support

– Especially our call

participants

Thank You

Health & Medicine

Falls Prevention/Injury Reduction Getting Started Kit – 2nd Edition – What’s New in Fall Best Practices?