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List interventions to use after assessment
Simple changes can reduce risk of falls
Assessing a patient's risk level for falls is an important part of any falls reduction program, but having a policy or guidelines that describe appropriate interventions also is essential.
"There are many factors that contribute to falls that we can control, even for hospice patients who live alone," says Charlene Ross, RN, MSN, MBA, partner and consultant with RBC Consulting in Phoenix. Environmental factors such as rugs that slip, low lighting, a lack of grab bars in the bathroom, or furniture that blocks pathways to the bathroom or other areas of the house can be easily addressed, she says.
"We also evaluate visual acuity to make sure their eyewear is the right prescription," says Jackie Crossen-Sills, PhD, PT, director of program development at Norwell (MA) VNA and Hospice in Norwell. Medications are assessed to see if the patient's caregiver needs additional education on the fall risks associated with various medications, she says.
In home health, physical or occupational therapy often is called upon to work with a patient at risk for falling, and it should be no different for hospice, says Ross. Assistive devices such as a walker or cane might provide extra stability for patients as they walk through the house, and a therapist can evaluate the patient for the proper assistance, she says.
A call to a therapist is not automatic for her agency, says Crossen-Sills. "We take the patient's diagnosis, stage of progression, and family dynamics into account, along with the nurse's professional opinion," she says. "We look at where the patient is in their journey and decide whether another clinician would be helpful or distressing."
Additional interventions used by the staff at the Hernando Pasco Hospice Care Centers in Florida include:
Bed is in lowest position with the side rails up.
Staff instruct patient and family on fall prevention interventions.
Patient's personal items are within arms' length.
Nonslip footwear is used.
Moveable equipment is locked prior to use.
Patients are transferred toward their stronger side.
Staff are to use bed or chair alarms as needed for patients.
Other interventions that can be used in a patient's home include:
Put bell within easy reach to call caregiver for assistance.
Sit patient on side of bed for two to three minutes before walking.
Use stools in shower so patient can sit.