Identifying causes of falls after the fact
Identifying causes of falls after the fact
Use risk assessment form, intervention
Home care companies normally perform home safety assessments when they open cases, but Mercy Home Care in Urbana, OH, has gone one step further. In addition to checking clients' homes upfront for fall hazards, they now use a falls risk assessment form to evaluate safety after a client falls.
"We were finding too many unwitnessed falls," says Patricia F. Haley, MSA, manager. "We were looking for ways to reduce falls and keep clients safer." Mercy had 300 reported falls during the most recent reporting year. So, a team of nursing and therapy staff conducted research and developed a risk assessment form and intervention protocol that Mercy began using about a year ago. (See sample form, p. 75.)
The form consists of 14 questions aimed at assessing patients' fall risk, such as the person's age, medication regimen, and perceived ambulatory steadiness. The goal is to ask very specific questions to elicit very specific answers. For instance, a standard daytime home safety review may not show that a hallway is dimly lit at night. Or a client may not disclose upfront that she doesn't like to use her walker when alone.
If the client answers yes to eight or more assessment questions after reporting a fall, Mercy nursing staff refers the case for physical therapy follow-up. Therapists use the Berg Balance Scale test to evaluate such issues as the client's gait and ability to stand without touching an object. Next, the therapists establish goals such as improving balance or developing a more appropriate gait.
If the client answers yes to fewer than eight assessment questions, the nurse discusses ways for preventing future falls, focusing on the cause of the original fall. For instance, upon first waking in the morning, a client may simply need to wait a couple of minutes before trying to get up.
Although outcomes are not yet available, Haley says field staff anecdotally report that many patients positively respond to less than eight assessment questions. This probably indicates that their fall was an isolated incident, she adds. And with Mercy's intervention, they should avoid repeat performances.
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