The ABCS of Fall Injury Prevention

1
The ABCS of Fall Injury Prevention

• A new look at preventing harm from falls

2
Defining Falls with Injury

• All documented falls with an injury level of
  minor or greater
• Minor indicates those injuries requiring a simple
  intervention.

3
Types of Falls
4
Where to focus?

• All Falls?
• Falls with Injury?
• What falls can be prevented?
• What injuries can be prevented?

5
Recommended Focus

• Preventable Falls
• Accidental Falls
• Anticipated Physiological Falls
• Prevent injury

6
Cost of an Injurious Fall

• Human Cost
• Pain
• Injury
• Fear of falling leading to decreased mobility
• Loss of independence
• Loss of life

• Monetary Cost
• Average 11,250
• 3,500-27,000
• Law suits

Cost reference Wu, S., Keeler, E., Rubenstein,
L., Maglione, M.A., Shekelle, P.G. (2010). A
cost-effectiveness analysis of a proposed
national falls prevention program. Clinical
Geriatric Medicine. 26. 751-766.
7
Did you know?

• Falls are the leading cause of death due to
  injury age 65 and older

• Risk Factors
• Recent fall
• muscle weakness
• behavioral disturbance
• agitation, confusion
• urinary incontinence and frequency
• prescription of culprit drugs
• postural hypotension or syncope

8
Other things we know about falls.

• 3-20 of inpatients fall at least once
• 30 to 51 result in injury
• 6-44 of these result in serious injury that
  could lead to death
• Fracture
• Subdural hematoma
• Excessive Bleeding
• Oliver D, Healey F, Haines T. Preventing falls
  and fall-related injuries in hospitals. Clinics
  in Geriatric Medicine. 201026(4)645-692.

9
Why is reducing harm from falls so difficult?

• What are the challenges?
• Why is it so difficult to achieve and sustain
  ZERO?

Brainstorm your ideas around challenges in
preventing falls
10
Fall Injury Prevention Failures

• Typical failures associated with patient
  assessment include the following
• Failure to recognize the limitations of the falls
  risk screening tools
• Lack of a standardized or reliable process for
  comprehensive fall risk assessment
• Lack of identification of patients at increased
  risk for a fall-related injury
• Lack of expertise in administering the assessment
  after positive risk screening
• Late administration of multifactorial and
  interdisciplinary assessment
• Lack of procedure for or time to consistently
  reassess change in patient condition
• Lack of clarity in expectations regarding patient
  assessment
• Failure to intervene quickly and link
  interventions to specific assessed risk factors
• Failure to reassess risk during patients entire
  hospital stay

11
Risk for fall

• Major focus for hospitals
• Everyone is at risk dilutes the significance
• New approach
• Who is at risk for INJURY?

12
Look at both
13

• ABCs
• Of
• Fall Injury rISK

14
Identify Patients at Risk for Injury

• ABCS

• A Age gt85
• B Bone (fracture risk or history)
• C anti Coagulation or bleeding disorder
• S Surgery during current episode of care

15
Age gt 85 years old

• Sensory Deficits
• Visual
• Hearing
• Sensation / Neuropathy
• Orthostatic Hypotension
• Mental Status changes
• Weakness due to immobility

16
Age gt 85 years old

• Teach Back Strategies
• Assistive Devices
• Sensory glasses / hearing aid
• Mobility
• Floor Mats
• Hip protectors if fracture risk
• Height Adjustable Beds (low when resting only,
  raise up bed for transfer)
• Safe Exit Side if patient is independent
• Medication Review
• Remove Ambien from order sets
• Pharmacist review for culprit medications

Population Specific Interventions
17
Bones

• Osteoporosis Diagnosis
• History of Fracture
• Osteoporosis Risk Factors
• Smoking
• Steroid use
• Alcohol use
• Chemo therapy

18
Bones

• Hip Protectors
• Low Beds
• Floor Mats
• Evaluation of Osteoporosis
• Vitamin D / Calcium

Population Specific Interventions
19
Coagulation/Bleeds

• Patients on Anticoagulants
• Platelet disorder
• History of excessive bleeding

20
Coagulation/Bleeds

• Evaluate Use of Anticoagulation
• Patient Education / Teach back
• Helmets TBI and Anticoagulants
• Wheelchair Users Anti-tippers
• Incorporate risk for internal bleeding in post
  fall assessment and interventions, i.e. CT scan

Population Specific Interventions
21
Coagulation/Bleeds

• Teach patients and families about the risk for
  bleeding with a fall
• In the Hospital
• In the Community

http//www.patientsafety.va.gov/docs/fallsToolkit/
EducationBrochure_Anticoagulants-102407.pdf
22
Surgical Patients

• Surgical procedure during current episode of care
• Lower extremity amputation
• Thoracic / Abdominal surgery

23
Surgical Patients

• Pre-op Education / Teach Back
• Call, Dont Fall
• Call Lights
• Post-op Education / Teach Back
• Pain Medication
• Offer elimination prior to pain medication
• Increase Frequency of Rounds

Population Specific Interventions
24
Injury Prevention Interventions

• Hip Protectors
• Floor Mats
• Low Beds

• Helmets
• Vit D and Calcium
• Osteoporosis
• Close monitoring
• Address sensory deficits
• Glasses, hearing aids, lighting
• Patient Family Engagement
• Teach back
• Pre op and post op Teaching
• Bedside handoffs
• Family monitoring

25
Best Practices in Preventing Falls

• Patient Family Engagement
• Pre op teaching
• Whiteboards
• Contracts
• Teach back
• Bedside Handoff
• Toileting supervision
• No one toilets alone
• Safety Trumps Privacy
• Scripting
• Proactive Mobility Programs
• Ambulation
• PT/OT

• Purposeful Rounding
• Possessions
• Pathway
• Potty
• Communication
• Safety Huddles
• Post Fall Huddles
• Weekly Fall Debriefs
• Medication Management
• Remove Ambien from order sets
• Pharmacist review for specific populations

26
Choosing Protective Equipment and Technology

• Engage staff and patients in selecting equipment
  to test
• Test equipment on a small scale
• Keep equipment accessible, and stored safely when
  not in use
• Avoid heavy reliance on bed and chair alarms to
  prevent alarm fatigue

27
Bedside Mats Fall Cushions
CARE Pad bedside fall cushion
Posey Floor Cushion
NOA Floor Mat
Roll-on bedside mat
Soft Fall bedside mat
Tri-fold bedside mat
28
Hip Protectors Examples
Safehip
KPH
HipGuard
CuraMedica
HIPS
29
Assistive technology for safe mobility-Bed
Chair Monitors
AirPro Alarm
Bed Chair Alarm
Chair Sentry
Locator Alarm
Economy Pad Alarm
Safe-T Mate Alarmed Seatbelt
Floor Mat Monitor
Keep Safe
QualCare Alarm
30
Key Resources

• HRET improvement guide http//hret-hen.org/injurie
  s-from-falls-and-immobility
• AHRQ Preventing Falls Toolkit http//www.ahrq.gov/
  professionals/systems/hospital/fallpxtoolkit/fallp
  xtoolkit.pdf
• VA National Center for Patient Safety Fall Tool
  Kit http//www.patientsafety.va.gov/professionals/
  onthejob/falls.asp
• IHI How to Guide on Injuries from Falls
  http//www.ihi.org/resources/Pages/Tools/TCABHowTo
  GuideReducingPatientInjuriesfromFalls.aspx

31
Contact Information

• Jackie Conrad RN, BSN, MBA
• Improvement Advisor
• Cynosure Health
• 708-420-1130
• jconrad_at_cynosurehealth.org