Interventions and Protocols Statistics In 2006, falls were

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Falls Prevention andBed Rail use

• Interventions
• and
• Protocols

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Statistics

• In 2006, falls were the third leading cause of
  injury related deaths at 10.2 per 100,000 in
  Washington State.
• This death rate was more than double the national
  average for injury related deaths at 4.6 deaths
  per 100,000.
• In Washington State, adults age 65 and older
  comprised over 2/3 of the hospitalized falls
  (12,502) and 82 (537) of fall-related deaths. 

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Care Plus Adult Family Homes Falls
Sustained Injuries
Statistics from January 2009 November 2009
3/6 falls from one 80 year old female resident
currently using side rails 4/8 falls from 83
year old female not currently using side rails
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Side Rail Safety Flow Chart Schmidt
Score____ Mobility Score____
Does the resident have dementia or confusion?
YES
NO
Side rail use may not be appropriate for this
resident. Consider alternatives.
Is the resident considered at risk for falling if
side rails are not used?
NO
YES
Are there gaps between rails and foot or head of
bed, the mattress, or gaps where resident
entrapment could occur?
Alternatives Identify
YES
YES
NO
Side rail use may be acceptable for this patient.
Was side rail use discussed with resident and
family?
Has assessment been completed and alternatives
discussed with resident and family?
YES
YES
Justify and record in Resident Notes
Document alternative measure used
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Examples

• Think of a patient that you would recommend side
  rails for.
• Assess whether side rails would be appropriate
  for this individual using the flow sheet.
• If side rails are not appropriate for this
  resident, can you think of some alternative
  interventions that would promote safety?

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Additional Interventions for Fall
Prevention and Safety

• Keep residents bed low to the ground.
• Place mats next to the residents bed to decrease
  injury.
• Place full length pillows along open side of bed
  place bed against wall.
• Utilize hip protectors.
• Keeping the room free of clutter i.e. loose
  cords, loose rugs, move furniture with sharp
  corners away from bed.
• Utilizing bed alarms.

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Residents Falls Risk Assessment Screen
  Schmidt Assessment Tool (1990)   MOBILITY
______ (0) Ambulates without gait
disturbance ______ (1) Ambulates or transfers
with assistive devices or assist ______ (1)
Ambulates with unsteady gait and no
assistance ______ (0) Unable to ambulate or
transfer   MENTATION ______ (0) Alert,
oriented x 3 ______ (1) Periodic
confusion ______ (1) Confusion at all
times ______ (0) Comatose/unresponsive   ELIMINA
TION ______ (0) Independent in
elimination ______ (1) Independent with
frequency or diarrhea ______ (1) Needs
assistance with toileting ______ (0)
Incontinence   PRIOR FALL HISTORY ______ (1)
Yes- Before admission (home or previous
facility) ______ (2) Yes- During admission
Date _______________ ______ (0) No ______ (1)
Unknown (by client)   CURRENT MEDICATIONS ______
(1) Anti-convulsants, tranquilizers,
psychotropics, hypnotics   Resident Score _____

Scored 3 FALL RISK Scored 3 not a fall
risk Scored 3 fall risk, explain
__________________________________________________
______________________________________   Scored
3 not a fall risk, explain _____________________
__________________________________________________
_________________
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Practice Scenario

• Ms. T is coming to you at the adult family home
  after care for her became too much for her son.
  She is 72 years old and has a history of PAD, an
  MI, anxiety disorder, depression, arthritis,
  osteoarthritis, osteoporosis, and incontinence.
  Past surgeries include a right knee replacement
  in 2003 and a left hip fracture 3 years ago after
  a fall she had at home. Ms. T is able to stand by
  herself, yet needs a walker to ambulate and can
  become unsteady at times. She is currently not on
  any opioids, anticonvulsants, benzodiazepines.
• Use the Schmidt Falls Risk Assessment to
  determine whether you feel the patient has a risk
  for falling while under your care.

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If a Resident Falls
Do not move resident
Call resident manager and Chris Thomson
CALL 911- Stay with resident until help
arrives. Check DNR status
Is resident breathing?
YES
NO
Findings to report to Triage person
Is resident ?bleeding ?unconscious ?fluid
draining from mouth, ears, nose
If resident is verbal, ask if he/she feels any
pain.
Check residents head, arms, legs, buttocks for
cuts and bruises. Check to see if any areas
look strange or out of shape (broken bones)
Make resident as comfortable as possible until
help arrives.
Apply ice packs and pressure to any bleeding area.
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Long Term Goal Objectives

• Long Term Goal To decrease falls and eliminate
  injuries related to bed side rail use.
• Objectives
• To decrease falls in all five Family First adult
  family homes by 50 within one year of
  implementation.
• To prevent injuries related to bed side rail use
  in all five Family First adult family homes
  indefinitely.  

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Healthy People 2010

• Two objectives were identified from Healthy
  People 2010 that related to falls and fall
  related injuries in the older adult.
• The first objective identified was reduce
  nonfatal unintentional injuries. Nonfatal
  unintentional injuries can occur from falls and
  injuries related to bed rail use. These types of
  injuries may be prevented through correct use of
  safety measures and bed rails.
• The second objective identified from Healthy
  People 2010 was reduce the rate of emergency
  department visits due to falls among older
  adults. Injuries sustained from falls and
  improper bed rail use can result in emergency
  department visits and can be prevented through
  correct use of bed rails and implementing safety
  precautions.

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Documenting Falls Injuries

• It is important to document falls, injuries
  sustained from falls, and injuries related to bed
  rail use in order to prevent further incidences
  from occurring.

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• Re-assessment of side rail need and fall risk
  should be done every twelve months or whenever
  the clients condition or medications change.
• Questions or Comments?