It's a well-known fact that many resident falls aren't preventable. But it's still our responsibility to decrease the risk of significant injuries related to falls.
A large study from Canada showed that frail, elderly patients face a significantly increased risk of mortality in the year after undergoing major elective, non-cardiac surgery. Being frail before surgery substantially increases the risk of adverse postoperative outcomes and that frailty had the strongest impact on the risk of mortality after total joint arthroplasty.
Preventing Injuries from Falls
So what does this mean to you? Let’s take a minute to think about our resident population. What are we doing to protect them from injuries that may require surgical intervention? We're all familiar with the risk of injuries related to falls, but what percentage of incidents in your community resulted in injury? Data is a great way to track and trend these types of adverse events, but incident data is just data unless you use it to improve the care of your residents.
QAPI is a process that, when used appropriately, is very effective in closing the loop on incident data collection by encouraging the team to perform root cause analysis. Through the PIP (Performance Improvement Process), the interdisciplinary team analyzes trends from beginning to end. Their goal is to identify causative factors that may assist in stopping the cycle.
However, the key is: what contributes to the trends to begin with? It's our resident population. Each incident, fall, etc. that a resident experiences adds to the data collection and trending process. What incident management system are you doing to stop this cycle?
Review Your Fall Prevention Program
Let’s go back to the basics of fall prevention programs:
- Assessments—a comprehensive, thorough assessment process should encompass all aspects of the resident profile—including medication regimen, which is often overlooked.
- Care Planning—establish resident-specific care plan interventions that meet the resident’s needs; avoid canned care plans as they are rarely effective!
- Education—don't limit this to the caregivers responsible for the resident’s care, but also educate the resident and family members.
- Assist devices—appropriate use of mats, height-appropriate beds, concave mattresses, etc. Remember, a low bed is not a one-size-fits-all intervention and may increase the risk of falls. Alarms have never proven to prevent falls, but just annoy the resident!
- Toileting—performing incontinence assessments will assist caregivers in anticipating toileting needs as it identifies times of day when the resident may need to use the bathroom.
- Rest periods—many residents enjoy a nap after meals. If you notice the resident is dozing in their wheelchair or their gait becomes unsteady, establish a nap program to allow them to rest.
- Mobility devices—if a resident needs assistance with ambulation, be sure the equipment is in good repair and meets the manufacturer’s recommendations. Don't modify a device unless the manufacturer specifically includes instructions.
- Skilled therapy—it's a standard to have residents screened by skilled therapy to determine if additional services would assist in preventing falls. This is a great practice!
So, to recap, frail patients are vulnerable to stressors and surgery puts an enormous physiological stress on even healthy patients. Is your community doing what needs to be done to prevent falls with injuries? It may be time to take a look at your incident management process, the effectiveness of your QAPI committee at trending incidents, and your data management. If you think you may need assistance in evaluating your process, contact your Evolucent risk manager for assistance!
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