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Reports drop by more than a third
A fall in the home can do more than leave a patient shaken and bruised: It can cause serious fractures, and lead to a severe overall decline in health for a person already vulnerable to illness.
Instituting a fall prevention program can be a proactive step to avert just such patient catastrophes. One California agency found that a simple program to assess fall risks and educate at-risk patients about preventative steps could make a big difference.
Reported falls at Home Care of America/San Marino (CA) dropped from 13 in 1998-99 to eight the following year, says Theresa Dudley, MSN, RN, director of patient care services.
Dudley says she developed the assessment tool for the program in response to concerns that her agency’s patients were at a higher-than-average risk for falls. "We could see from our risk management logs that we had too many fractures," she says, noting that Home Care of America has population that’s older than the norm by home health standards.
Dudley studied log entries of falls and their causes to develop a list of risk factors that can contribute to falls in the home."When nurse calls in regarding a fall, we log it, we find out what happened and get the particulars," she says. "I developed a tool, an environmental assessment ( see insert) that helped our nurses determine if the patient was a high risk or not."
The two-page assessment tool looks at risk factors in a variety of areas:
• Physical — asking about conditions such as vertigo, unsteady gait, impaired vision, pain, or other physical factors that can cause a person to be less coordinated.
• Medication — asking if a patient is taking sedatives, antihypertension drugs or other drugs that can cause dizziness or other symptoms that can lead to falls.
• Environmental factors — checking for physical factors in the home that can lead to falls, such as stairs without handrails, slippery floors, throw rugs, clutter, even a small dog running around and getting underfoot.
Other factors, which can include anything from an inattentive caregiver, alcohol use, and improper use of assistive devices to urinary incontinence. Some risks were more prominent than others, Dudley says.
The assessment tool was included in every admission packet and administered as part of the overall initial assessment.
Any patient found to have two or more such risk factors was said to be at high risk for falls and became part of the program. Those patients received an education component also developed by Dudley from a wide range of material. "I have a very large home health library at our office, with many books of handouts that can be distributed for patient education," she says.
Topics covered included safety tips for various rooms of the house, including kitchens and bathrooms, safety in stairwells, walking with canes and other assistive devices and safety for Alzheimer’s patients.
There was a teaching guide for the nurse as well as the patient. Inservicing was held to explain the program to the nurses and instruct them in how to do the assessment and teaching.
Dudley says the teaching was targeted at nurses because fall prevention isn’t necessarily an area of expertise in nursing. "With physical therapy, that is their concentration — developing strength, exercises etc. That’s why I addressed this pretty much to nurses."
If a patient who wasn’t on the program suffered a fall, he or she was immediately added to the prevention program. Each fall also generated a fall incident report, which looked again at the factors that led to the accident ( see insert). Among the questions was an assessment of the patient’s mental state: Was he or she confused? Alert? Disoriented?
The education program made a real difference, Dudley says. "There was definite improvement," she says, noting that of the eight falls reported during 1999-2000, only one required hospitalization.
Dudley hopes to do follow-up telephone monitoring of patients to see if their new safety awareness has persisted beyond discharge. She adds that she would like to have solicited more feedback from nurses on what was occurring in the homes as they used the program, to tailor it to individual needs.
"I should have gotten more feedback from them on whether or not we needed to re-evaluate or reassess or to continue with what we were doing with each particular person who was on the program," she says.
But overall, she was pleased with the success of the program. Dudley says that while the fall prevention assessment tool is not an official part of the initial assessment anymore, prevention efforts still are a priority at the agency.
"It’s not part of the evaluation packet, but nurses are very much aware of who requires additional teaching because they’ve been doing it for months," she says.