MODULE 1 Patient Falls

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MODULE 1 Patient Falls
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Facts About Falls
MODULE 1 Patient Falls

• An estimated 15,240 End Stage Renal Disease
  patients fall in
• dialysis facilities nationwide every three
  months.
• 40 percent of patients who fell cited dizziness
  as the main reason
• for their fall.
• Tripping, slipping, loss of balance and weakness
  are also
• contributing factors.
• Once patients fall, they may become more cautious
  and less
• physically active thereby becoming weaker and
  increasing the
• likelihood of future falls.

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Preventing Patient FallsIs Key to Keeping
Kidney Patients Safe
MODULE 1 Patient Falls
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Contributing Factors
MODULE 1 Patient Falls

• Impaired Cognition
• Degenerative Arthritis
• Peripheral Neuropathy
• Peripheral Vascular Disease
• Lower Extremity Amputation
• Living Alone

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Contributing Factors
MODULE 1 Patient Falls

• Vision Impaired
• Environmental Factors
• Medications
• Assistive Devices
• Poor Physical Functioning
• Prior Fall
• ID Fluid Removal

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Fall Prevention Best Practices
MODULE 1 Patient Falls

• Patient Fall Risk Assessment
• Educational Programs
• Physical strengthening/therapy
• Pre-Dialysis Assessment Prior to Each Treatment
• Fall Reporting and Physician Notification
• Dialysis Heparinization for Patients with Prior
  Falls

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Patient Fall Risk Assessment
MODULE 1 Patient Falls

• Physical Conditioning Assessment
• Medication Review
• Home Environment Questionnaire
• Dialogue with Patient and Caregivers
• Physical Conditioning/Therapy Needs Assessment

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Focused Education Program for Patients,
Caregivers and Staff
MODULE 1 Patient Falls

• New staff trained in all fall risk assessment
  procedures and fall prevention policies
• Additional training provided to staff during
  in-service training and as need arises
• Fall prevention policies reinforced through
  newsletter articles, brochures and bulletin
  board postings
• Patients and caregivers offered information and
  education opportunities

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Physical Strengthening/Therapy
MODULE 1 Patient Falls

• Address physical functioning/strength issues
• May include referral to a physical therapist
• May include recommendation for an assistive
  device
• Individually tailored strength training to
  increase patients coordination and muscle
  function

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Pre-dialysis Risk Assessment
MODULE 1 Patient Falls

• Ask patient about falls occurring since previous
  dialysis
• Enter information into patients medical record
• Determine need for physician notification and/or
  adjustment in dialysis heparinization

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Physician Notification
MODULE 1 Patient Falls

• When serious injury results from a fall
• When falls occur in the dialysis facility
• When there is any acute change in patient
  condition subsequent to a fall
• When there is a head injury with active bleeding

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Dialysis Heparinization
MODULE 1 Patient Falls

• For patients who have fallen prior to dialysis
  treatment, anticoagulation may be adjusted
• Heightened alert for patients receiving Warfarin
• Prothrombin time/International Normalized Ratio
  before dialysis subsequent to fall or injury
• Consider decreasing/withholding heparin

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MODULE 1 Patient Falls
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Which of the following is NOT a contributing
factor to patient falls?
MODULE 1 Patient Falls

• Poor physical functioning
• No record of prior falls
• Living Alone
• Impaired Cognition
• ID Fluid Removal

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Which of the following is NOT a contributing
factor to patient falls?
MODULE 1 Patient Falls

• Poor physical functioning
• No record of prior falls
• Living Alone
• Impaired Cognition
• ID Fluid Removal

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Which of the following IS part of an effective
patient falls risk assessment?
MODULE 1 Patient Falls

• A. Knowledge of patients likes and dislikes
• B. Review of patient punctuality
• C. Number and age of close family members
• D. Home environment questionnaire
• E. Level of interaction with other patients

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Which of the following IS part of an effective
patient falls risk assessment?
MODULE 1 Patient Falls

• A. Knowledge of patients likes and dislikes
• B. Review of patient punctuality
• C. Number and age of close family members
• D. Home environment questionnaire
• E. Level of interaction with other patients

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True or False
MODULE 1 Patient Falls

• Recommending the use of assistive devices to
  patients is inappropriate in dialysis centers.

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True or False
MODULE 1 Patient Falls

• Recommending the use of assistive devices to
  patients is inappropriate in dialysis centers.
• FALSE
• Recommending assistive devices may be part of
  effectively addressing patient physical
  functioning and strength issues affecting the
  risk of patient falls.

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Prior to dialysis, patients should be asked about
MODULE 1 Patient Falls

• Any falls that have occurred since their last
  dialysis treatment
• Falls occurring ONLY in the dialysis facility
• Any fall that resulted from dizziness
• ONLY falls that resulted in injury

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Prior to dialysis, patients should be asked about
MODULE 1 Patient Falls

• Any falls that have occurred since their last
  dialysis treatment
• Falls occurring ONLY in the dialysis facility
• Any fall that resulted from dizziness
• ONLY falls that resulted in injury

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The physician must be notified
MODULE 1 Patient Falls

• When a patient requests physician notification
• ONLY when the fall results in serious injury
• ONLY when a fall occurs in the dialysis facility
• D. When there is any acute change in patient
  condition subsequent to a fall
• E. ONLY if the fall was witnessed by two or more
  people

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The physician must be notified
MODULE 1 Patient Falls

• When a patient requests physician notification
• ONLY when the fall results in serious injury
• ONLY when a fall occurs in the dialysis facility
• D. When there is any acute change in patient
  condition subsequent to a fall
• E. ONLY if the fall was witnessed by two or more
  people

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Adjustment in dialysis heparinization should be
considered
MODULE 1 Patient Falls

• ONLY if a patient requests it
• When a Prothrombin time/International Normalized
  Ratio has been performed
• When a patient receives Warfarin
• When a patient has fallen prior to dialysis
  treatment.

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Adjustment in dialysis heparinization should be
considered
MODULE 1 Patient Falls

• ONLY if a patient requests it
• When a Prothrombin time/International Normalized
  Ratio has been performed
• When a patient receives Warfarin
• When a patient has fallen prior to dialysis
  treatment.

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Additional Resources About Fall Prevention
MODULE 1 Patient Falls

• Joint Commission National Patient Safety Goals
  - www.jointcommission.org/PatientSafety/NationalPa
  tientSafetyGoals/
• National Guideline Clearinghouse
  www.guideline.gov
• National Institute for Health and Clinical
  Excellence www.nice.org.uk/Guidance/CG21