Critical Path Network-Practice guideline tackles fall risk

Medical Directors' algorithm aids risk assessment

The American Medical Directors Association in Columbia, MD, and the American Health Care Association in Washington, DC, have developed an algorithm and clinical practice guideline on patient falls. (See algorithm and fall risk checklist, pp. 40-42.) These tools are intended to guide caregivers in assessing and managing individuals who have a recent history of falls or who are at risk. The guideline is relevant for any situation, whether aggressive or more limited care is desired.

Conditions representing risk factors for falls include:

• previous falls, fear of falling, history of fractures;

• cardiac arrhythmias, transient ischemic attacks, stroke;

• Parkinson's disease;

• delirium, dementing illnesses, depression, acute and subacute medical illnesses;

• musculoskeletal conditions such as myopathy and deformities, problems with mobility or gait;

• orthostatic hypotension, dehydration, hypoglycemia;

• incontinence of bowel or bladder;

• visual or auditory impairment, dizziness;

• use of restraints;

• polypharmacy.

Medication categories commonly associated with injury from falling include:

• anticoagulants, antidepressants, antiepileptics, antihypertensives, anti-Parkinsonian agents, vasodilators;

• benzodiazepines, diuretics, narcotic analgesics, nonsteroidal anti-inflammatory agents (NSAIDS), psychotropics.

Complications from falling include:

• abrasions, contusions, lacerations, ecchymosis, hemorrhage;

• anemia;

• concussion, subdural hematoma;

• fracture, sprain, or dislocation;

• fear of falling resulting in loss of confidence, decreased independence, and social isolation.

Environmental factors associated with falling include:

• dim lighting, glare;

• poor or weak seating;

• use of full-length side rails, inadequate assist devices;

• inappropriate footwear, poorly fitting eyewear;

• uneven flooring, loose carpet, wet slippery floor;

• lack of safety railings or bathroom grab bars;

• malfunctioning emergency call systems;

• poorly positioned storage areas.

Guideline and algorithm reprinted with permission of the American Medical Directors Association, Columbia, MD. For more information about this guideline, call (800) 876-2632 or (410) 740-9743.