Capstone Project: Falls Prevention and Risk Assessment of the Elderly Population while in Long Term Care facility Evidence Based Practice – NUR 4775L Dr. Susan Poole, DNP, CNE November 22, 2015 Capstone Part I: Falls Prevention and Risk Assessment of the Elderly Population while in Long Term Care facility Introduction to Problem According to Centre for disease Control (CDC) more than 1.4 million people 65 and older live in nursing homes. If current rates continue, by 2030 this number will rise to about 3 million (CDC, 2014). Nursing home residents are at an increases risk for falls depending on the acuity of their illness and their mental state.
The second article that was reviewed came for National Guideline Clearing house (NGC, 2012). The methods used to analyze the evidence were review of published meta-analyses and systematic review. The major outcomes considered in the study were sensitivity, specificity, and reliability of screening tools, risk factors for falls and fall rates. There were numerous recommendations that were recommended to reduce and prevent falls among the elderly population. However the best practice in fall reduction includes falls risk assessment , visual identification of individuals at high risk for falls , falls risk directed interventions and standardized multifactorial education including visual tools for staff, families, and patients (NGC, 2012).
Hence, the role of a community physiotherapist can include making a referral to an occupational therapist (WCPT, 2003) as he or she could help in assessing and modifying the home environment to make it an elderly friendly apartment. Apart from physiotherapists, occupational therapists can also help in facilitating the patient’s safety. In addition, the bathroom which is the location of the fall should be assessed and identified for any hazards to prevent future falls. A study by Cumming et al. (1999), it was shown that occupational therapists were able to impede future falls in the elderly by visiting the patients’ homes so that the patients will be able to live safely.
Problem Identification Getting out of bed is one of the dangerous things that the elderly patients do when they are admitted in the hospital. Study conducted by Ambrose, Paul & Hausdorff, (2013) on patient falls reveals that a majority of falls in the elderly patients occur between 0700 and 1900, especially when they are getting out of bed to use the rest room. The cause of their falls is mainly due to unsteady gait, memory loss, confusion that comes with age. Memory loss and vision problems which occurs during old age in the elderly patients puts them at risk for falls. Other factors that can lead to falls are; Presence of throw rugs, psychotropic medications, lack of Vitamin D, and weakness of the lower extremities.
Consider physiological and environmental risk factors for falls. Patients at greatest risk for OH are the elder population 65 and older. “Orthostatic hypotension (OH) is associated with significant morbidity and mortality among older people. (Lampela, Lavikainen, Huupponen, Leskinen & Hartikainen, 2013)” Several risk factors must be taken into consideration when assessing fall risk.
This program, called the Nijmegen Falls Prevention Program, included one hundred thirteen elderly clients with a history of falls. Exercise sessions were held twice a week for five weeks with fall monitoring done before and after the experiment. Control assessments were also done continuously thru the study to determine client changes in standing balance, balance confidence, and obstacle avoidance skills. The results of the Nijmegen Falls Prevention Program showed that the number of falls within the exercise group dropped by a significant forty six percent! Not only less falls, but obstacle avoidance skills dramatically improved as did balance
It also provided the use of critical thinking and clinical judgment on how to prevent falls, support, and be accountable for a client professionally. The practical knowledge I have learned helped me become aware of assessing and assisting a client. As a nurse, our job is to provide “safe, compassionate, competent and ethical care” (p.8) and collaborate as an interprofessional team to deliver safe care and prevent risks from happening while offering quality nursing care (CNA, 2017). I will always provide the professional care under the code of ethics to promote health and wellness for an older adult and prevent risks from happening. As well as following the plan of care, use communication strategies, be aware, acknowledge, and accommodate individuals with different diseases such as with dementia, to promote fall prevention strategies (RNAO, 2017).
Present the Evidence: Prevention of Patient Falls According to the Centers for Disease Control (CDC), each year, one third of those who are 65 and older fall (2013). These falls contributed to $34 billion in direct medical costs in 2013 (cite). With these statistics, it is apparent that health care professionals and health care settings need to make fall prevention a priority in their facilities. The aim of this paper is to explore a fall prevention policy and practice guidelines to evaluate recent evidence and offer recommendations.
Evidence Based Practice Proposal- Section D: Solution Description The Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) to have higher sensitivity in assessing fall risk in the geri-psychiatric population (Edmonson et. al, 2011). This project of EPFRAT will let the progress of a fall risk prevention protocol to provide the safest environment and best quality of care possible for the geriatric psychiatric inpatient.
This essay will discuss a chosen individual with hip fracture from practise placement and explore the context to which health and social care is administered in the UK. CMOP-E model will be used to examine the theoretical concepts of occupational therapy and the identification of occupational performance needs of the chosen patient. The role of multi disciplinary team participation will be discussed with reference to the patient’s treatment whilst demonstrating safe practise in relation to personal safety and safety of others. An 89 years old lady was admitted to the hospital due to a fall at home and fractures her right hip. Mrs Jones (pseudo name) lives alone in a three - bedroom house privately owned with stair lift, bedrooms and bathroom
I will also discuss on how this clinical situation could be done differently. Clinical scenario I was posted to a medical ward in National University Hospital for my clinical posting. There is a particular cubicle allocated for patients with very high risk of fall called the “Green eye cubicle “. Patients in that cubicle are usually confused or not compliant to fall precaution.
This is reviewed with any change in patient status, a fall, and/or quarterly. Patients, depending on screening, might receive services from physical therapy (PT), occupational therapy (OT), nutritional services, bed/chair alarms, floor mats, medication adjustment, and change in room to closer to the nurses’ station, or other services. All at risk patients are easily identifiable by notation on wrist band, footwear, room and equipment signage, in the electronic medical record, and on any paper records. The fall rate of patients at SAVAHCS continues to be at or slightly below the benchmark, but our goal is to have zero falls. The intervention not fully utilized at this hospital, that does show promise in the literature, is the post-fall huddle.
This act created a major revision of standards of care for nursing homes. This legislation also changed the expectations and the quality of care that patients should receive in long term care facilities. This Nursing Home Reform Act passed by congress specifically stated “that each residents have the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms”. While there may be some benefits to using restraints in nursing homes, however, studies have shown that using restraints in nursing homes negatively impacts patients and for the most part does not prevent them from falling or from other incidents that may occur. There are very high levels of risks associated with the use of restraints (Lapane,150).
Falls of critically ill patients admitted to the ICU routine should be avoided developing certain strategies used outside this area, such as prevention of displacement, promote stability, elimination of sliding hazards routinely ensure that the patient is oriented to the environment and the bell is at the fingertips, keeping the beds in the lowest position and braking, providing adequate lighting, and provide anti-slip footwear and technical assistance in lifting patients bed. The response time of the call prolonged ringing patient or family is just one of the potential causes of falls, firstly because if the response time is greater serve their needs later, and partly because no response to the patient may start feeling agitated. Shift schedules nurses can be particularly effective in preventing falls, as they allow the staff to anticipate and address the needs of each patient. The tubing, drains and cables must be securely to prevent tripping when lifting or embody patients. Although falls can happen without warning, subsequent falls can be avoided if the etiology of them is