Falls Prevention/Injury Reduction Getting Started Kit – 2nd Edition – What’s New in Fall Best Practices?

www.saferhealthcarenow.ca
Presenters:
Dr. Fabio Feldman
Dr. Vicky Scott
Hélène Riverin
Brenda Dusek
Falls Prevention/Injury Reduction Getting Started Kit – 2nd Edition
What’s New in Fall Best Practices?

Date: Tuesday June 25, 2013
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Falls Prevention/Injury Reduction Getting
Started Kit
2nd Edition
What’s New in Fall Best Practices
Hosts
Brenda Dusek
RNAO iaBPG Program
Manager
Falls Intervention Lead
National Call Host
Gina Peck
Administrative Assistant/Office
Coordinator, Atlantic Canada
Canadian Patient Safety Institute
Technical Support
Hélène Riverin,
Safety and Improvement Advisor
Quebec
French Support

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Falls Prevention/Injury Reduction
Intervention Model – What’s New?

Dr. Fabio Feldman
Presenters
Dr. Vicky Scott Hélène
Riverin
Brenda
Dusek

A Fall?
An event that results in a person coming to rest inadvertently on the
ground or floor or other lower level, with or without injury – which
includes:
•Unwitnessed fall = where the client is able/unable to explain the
events and there is evidence to support that a fall has occurred.
What’s New?
Definition Adjustments

A Near Fall?
A slip, trip, stumble or loss of balance such that the individual
starts to fall but is either able to recover (witnessed or
unwitnessed) and remains upright because their balance recovery
mechanisms were activated and/or caught by staff/other persons,
or they were eased to the ground or floor or other lower level, by
staff/other persons e.g. could not stop or prevent falling to the
ground, floor or lower surface.
What’s New?

What is a Fall Injury?
An injury that results from a fall, which may or may not require
treatment. The injury can be temporary or permanent and vary in
the severity
of harm.
What’s New?

SAFE ENVIRONMENT, ASSIST WITH MOBILITY, FALL RISK REDUCTION, ENGAGE CLIENT AND FAMILY
• Assess all clients on
admission, on a regular
schedule, and following
change of status and
following a fall
MULTIFACTORIAL
RISK ASSESSMENT
• Communicate the results
of the fall risk assessment
to the client and family,
and healthcare team
• Educate all staff on fall
prevention/injury
reduction strategies and
on specific fall risk
factors
• Educate all clients who
have been assessed at
high risk for a fall and
fall-related injury and
their family regarding fall
risk status
COMMUNICATION
AND EDUCATION
ABOUT FALL RISK
IMPLEMENT
INTERVENTIONS
FOR THOSE AT
RISK OF FALLING
• Implement
individualized
interventions
targeted to the
client-specific risk
factors.
• Modify the
environment and
provide personal
protective devices
INDIVIDUALIZE
INTERVENTIONS FOR
THOSE AT HIGH RISK
OF A FALL-RELATED
INJURY
•Client Level:
•Create an individualized
care plan based on identified
risk factors
•Organizational Level:
•Develop policies for fall
prevention/injury reduction
management, that includes:
HCP and organization role
responsibilities for fall risk
assessment
•Develop an approach for
regular safety checks
•Investigate falls, near falls
(includes unwitnessed) to
determine contributing factors
Prevention: Universal Fall Precautions (SAFE)
Falls Prevention/Injury Reduction Intervention Model
What’s New?

Prevention: Universal Fall Precautions (SAFE)

Multifactorial Risk Assessment – What’s New?
Risk Factors for Falling:
Use of adapted BBSE MODEL of fall-related risk factors:
Scott,, V. (2012). Fall Prevention Programming: Designing, implementing and
evaluating Fall Prevention Programs for older Adults. Raleigh, North Carolina: Lulu
Publishing.
What’s New
Increased focus on:
(Intrinsic)
Risk Factors
Biological  Pertain to the human body
 Multiple factors increases fall
risk
 advancing age
 chronic disabilities
 visual impairment
 inadequate hydration and/or
nutrition
(Extrinsic)
Risk Factors
Behavioural  Understanding the
association between risk
factors and a person’s
actions, emotions & that
increase the risk
 multiple medications
 Inadequate hydration/nutrition
Social and Economic Conditions/circumstances that
permit/shape health:
 social isolation
 poor support networks
 socially deprived populations
 culture and ethnicity
 low income (below $15,000)
 living conditions e.g. supports
 income impacts on food choices
Environmental  associated hazards within our
physical surroundings
 home hazards
 support aids: balance, visual etc
 accessibility

Fall Risk Factor
Assessment Tools – What’s NEW?
More explanation of categories and classifications for fall
risk assessment tools:
Categories:
1. Multifactorial tools
2. Functional mobility tools
3. Environmental Hazard Checklists
Classifications:
•Quick Screening
•Comprehensive

Screening Parameter
Screening Tool and Approach Chart- Figure 5
Screening parameter
Appropriate Screening Tool(s) and Approach
Screen for physical and
functional status (*See
examples of tools in
Appendix D*)
Some examples of tools that could be used to screen for
physical or functional status include
Quick Screen:
 *Timed Up and Go
 Sit-to-Stand
 Tandem Stance
 Functional Reach
Other Assessment tools
 Scott Fall Risk Screen Tool (SFRS)©
 *Berg Balance Scale
 Fullerton Advanced Balance (FAB) scale
 Stop walking when talking
 The BESTest (balance evaluation system test
 * Tinetti Performance Oriented Mobility Assessment
(POMA)
 Walking speed

Screening parameter Appropriate Screening Tool(s) and Approach
Screen for cognitive
impairment
Examples of tools that could be used to screen for cognitive
impairment include:
 Mini-Mental Status Exam (MMSE)
 Confusion Assessment Method (CAM)
 Mini Cog available at
 Montreal Cognitive Assessment (MoCA)
Screen for osteoporosis Osteoporosis screening and intervention are imperative to
prevent fractures in all men and women over the age of 50
years. When risk factors for osteoporosis – consider BMD
testing Further facts and statistics are available at
http://www.osteoporosis.ca/index.php/ci_id/8867/la_id/1.htm
Fracture Risk Assessment Tools:
 The Canadian WHO Fracture Risk Assessment Tool
(FRAX); and
 Canadian Association of Radiologist and Osteoporosis
Canada (CAROC)
Both can be accessed at
http://www.osteoporosis.ca/multimedia/tools.html.
Screening Parameter
Screening Tool and Approach Chart – Figure 5

Screening parameter Appropriate Screening Tool(s) and Approach
Screen for hearing and visual acuity Vision screening tools provide a quick and easy approach to vision
assessment to determine if visual impairment.
•A Vision Screening Kit available at: Misericordia Health Centre which
focuses on Falls Prevention & Vision screening @
http://www.misericordia.mb.ca/AboutUs/VisionScreening.html
 The Centre for Eye Research Australia has examples of vision
screening tools: http://www.cera.org.au/our-work/resources/vision-
screening-tools.
Example kit contents:
 Vision Screening Booklet
 Pinhole
 E Card Booklet (Near and Distance visual acuity)
 Matching Card
 E Card Tests:
o Distance –6/6, 6/12, 6/18, 6/60, 3/60
o Near – N8, N20, N48
Screen for malnutrition (*See
examples of tools in Appendix E*)
and dehydration
Assess current nutrition risk with valid tools such as:
*MST, *SCREEN© or *MNA-SF®.
Several recommendations to improve food intake can be made based
on screening tool risk factors;
Refer high risk clients who require a full
assessment to a dietitian.
Screening Parameter
Screening Tool and Approach Chart –
Figure 5

EXAMPLE: Long Term Care,
CSSS de la Vieille-Capitale;
2013.
A logo is used according to the score
•Client screened with the Scott Fall Risk Screening Tool
•All identified risks addressed
•Score above 12 on the screening tool = high risk of falling and unsafe
ambulation
•Surveillance increased
•Identifier used
Communication of Fall Risk -

Implement Interventions for Those at Risk for Falling
Canadian Fall Prevention Curriculum Model - BEEEACH
Reproduced with permission Vicky Scott, PhD; 2013.

Interventions Known to Modify Fall Risk Factors- Figure 7
Risk Factors for Falls Interventions known to modify risk based on fall risk factor
Age, over 80 years of age
Fear of falling  Encourage the individual to verbalize feelings.
 Strengthen self-efficacy related to transfers and ambulation by
providing verbal encouragement about capabilities and
demonstrating to the individual their ability to perform safely.
History of previous falls or near
falls
 Identify the client as being at risk for a fall or near fall reoccurrence.
 Communicate risk by use of a visual identifier.
 Address causes of falls based on past fall assessment.
 Further assess physical function, balance etc.
Acute illness, such as UTI,
pneumonia, etc.
 Treat acute condition and re-evaluate risk factors. Increase
observation- e.g. nurse rounding.
Chronic illness and or conditions,
such as stroke
(balance/mobility/limb paralysis),
hypotension, postural
(orthostatic) or Post-prandial
hypotension, depression, etc.
 Treat chronic condition and re-evaluate risk factors.
 Educate client on the risks associated with condition e.g. change in
posture leading to postural orthostatic hypotension.

Interventions Known to Modify Fall Risk Factors- Figure 7
Medication reviews should include review of the client’s medical
conditions/diagnoses/health problems and medications prescribed which includes:
1. Use of:
•non-prescription medications
•natural health products
2. Description of how the client is actually taking the drug products
3. Identification of any:
•condition not treated or undertreated
•drug product taken without an indication
•drug being misused (e.g. excessive duration or dose)
•high-risk medication being used with the potential to increase the risk of
falling (See Appendix B)
4. Treatment for bone health including over the counter Calcium and
Vitamin D (Prevention and Treatment of Osteoporosis
Section )

Define the
Problem
Identify Fall Risk
Factors
Examine
Fall Prevention/
Injury Reduction
Best Practices
Implement the
Fall Prevention/
Injury Reduction
Program
Evaluate
Fall Prevention/
Injury Reduction
Program
Adapted: A Public Health Approach to Fall Prevention Among Older Persons in Canada Model
Figure 8
Public Health Approach Model
Adapted with permission, Elsevier Limited, The Boulevard, Langford Lane, Kidlington,Oxford,
OX5 1GB,UK ; Authors: Vicky Scott, Brandon Wagar, Alison Sum, Sarah Metcalfe, Lori Wagar; 2013.
Organization Strategies - Implementation

Restraint Use
Home Health Care
Policy and Procedures – Restraint Use

Individualize Interventions
for
Those at High Risk of a Fall-Related Injury
•Figure 9 Risk Fall, Hip Fracture
and Severity of fall Injury: This
chart reviews factors that increase
risk for fall or hip fracture or
factors that potentiate severity of
injury
•Figure 10 Chart focus on
Interventions that prevent or
minimize risk/ severity of injury
•Additional focus in this section on
Osteoporosis – pharmacological
interventions & exercise, injury
site protection

for
•Additional focus
in this section
on:
Osteoporosis –
pharmacological
interventions

for
•Additional focus in this section on
Exercise

for
•Additional focus
in this section on
Hip Protectors

New Indicators
There are now seven measures for Acute Care and 8 Measures for Long Term Care:
NEW: 8. (# 8 Long Term Care but # 7 for Acute Care):
Injury Rate related to falls (Fall Related INJURY Rate) per 1000
patient/resident days (Outcome Measure)
Measuring the Success of Fall
Prevention/Injury Reduction Programs
Total Number of Injuries (Fall related INJURY) related to falls reported this
Month
Total Number of Patient/Resident Days on the Facility or Unit within the
Facility this month
x 1000 = Injury Rate related to falls (Falls Related Injury Rate) per 1000
Patient/Resident Days

New Indicators
There are now six measures for Home Health Care:
NEW: 6. (NEW) Restraint Use (Balancing Measure)
Measuring the Success of Fall
Prevention/Injury Reduction Programs
Total Number of Clients Receiving Home Health Care with Restraints
Applied
Total Number of Clients Receiving Home Health Care in the same
time period
x 100 = Percentage of Clients with Restraints

GSK – 2nd Edition available at:
http://www.saferhealthcarenow.ca/EN/Interventions/Falls/Pages/
resources.aspx

Questions
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Special Thank You
SHN Falls Intervention Faculty 2013
Cheryl Sadowski, PhD
Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta
Donna Davis
Co-chair, Patients for Patient Safety Canada, Carievale, Saskatchewan
Brenda Dusek RN, BN, MN
Program Manager, IABPG, RNAO, Toronto, Ontario
Fabio Feldman, PhD
Manager, Seniors Fall and Injury Prevention, Fraser Health Authority
Kimberly Fraser, PhD
Assistant Professor, Faculty of Nursing, University of Alberta, Edmonton, AB
Nadine Glenn
CPSI, SIA SHN
Heather Keller RD, PhD
Schlegel Research Chair Nutrition & Aging Department of Kinesiology, University of Waterloo, Ontario
Anne MacLaurin, RN, BSCN, MN
CPSI, Project Manager, SHN

Special Thank You
Susan McAlpine, B.Sc.P.T.
Physiotherapist, CSSS d’Argenteuil, Lachute, Quebec
Coordinator of Clinical Education, Physical Rehabilitation Program, Dawson College, Montreal, QC
Heather McConnell
Associate Director, IABPG, RNAO
Alexandra Papaioannou, BScN, MSc, CIHR, MD
Eli Lilly Chair Professor of Medicine McMaster University, Hamilton Health Sciences, Ontario
Vanina Dal Bello-Haas, PT, PhD
School of Rehabilitation Science, McMaster University, Hamilton, Ontario
Rayma O’Donnell
Director of Care Services, York Manor, Fredericton, New Brunswick
Carla Marie Purcell, RN, BScN,
Clinical Nurse Educator, Capital Health, Halifax, Nova Scotia

Special Thank You
Helene Riverin
Conseillère clinicienne en physiothérapie, CSSS de la Vieille-Capitale, Quebec
Vicky Scott, PhD
Senior Advisor on Fall & Injury Prevention, British Columbia Injury Research &
Prevention Unit and Ministry of Health Services, Victoria, BC
Laura M. Wagner, RN, PhD,
Adjunct Scientist, Rotman Research Institute, Baycrest, Toronto, ON

• Special Thanks to:
– Falls Prevention/Injury
Reduction Intervention
Faculty
– Guest Speakers
– Technical Support
– Especially our call
participants
Thank You

Falls Prevention/Injury Reduction Getting Started Kit – 2nd Edition – What’s New in Fall Best Practices?

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