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Improving LTC Safety to Reduce Falls Injuries

Improving LTC Safety to Reduce Falls Injuries

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Published by Janusz Kaleta
Falls prevention in Long Term Care Homes
Falls prevention in Long Term Care Homes

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Published by: Janusz Kaleta on Sep 08, 2012
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11/17/2012

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:l
'.:.
aa
Falls
Prevention
With
as
many
as
50Vo
of
residents
in
long-term
care
homes
falling
each
year,10Vo
of
whom
sufferingserious
injury,
a
Tbronto
nursing
homeelected
to
ioin
the
National
Collaborative
on
Falls
Prevention
in
Long-Term
Care
Homes.
The
goal
wasto
de'
crease
the
number
of
falts
amongits
residents
by
25Vo
and
to
reduce
the
numberof
injuries
within
six
months.
Compared
to
the
previous
year,
therewere
24%o
fewer
falls
resulting
in injuries,
and
no
residents
sufferingserious
injuries
such
aship
fractures.
By
Janusz
Kaleta
Improving
tTC
safety
to
reduce
falls
injuries
Tl
esearch
completed
in
2007
by
l(,n.
ontario
lnjury
PreventionResource Centreshowsthat
every
10
minutes
at
least one senior
visits
an
emergency
departmentdue
to
a
fall
(OIPRC,2007).One
third
ofall
adults
over
age
64,
living
outside
of
institu-tions,
fall
eachyear,
with
the
likeli-
hood
of
falls
increasing
with
older
age
(Stevenset
al.,
2006).
More
vulnerable
in
IjTC
LTC
residents, onthe otherhand,
are
nearly
three
timesmore
likelyto fall
than
elders
livingin
thecommunity
(Panelon
falls,
2001).
Compared
withcommunity-dwellingelders,
nursing
home
residents
generallyhave
moreco-morbidities
andadvanced
diseases,
including
dementias, therebymaking
them
morevulnerable
to
falls.
In
a100-bed
facility,
for example,
there
will
generally
be
between
100 and
200
falls
eachyear,
with
many
residents
falling
more than
once
(CDC,
2008).
Fallsoftenresult
in
serious
injuries
such
as
hipfractures
andheadtrauma,
especially
when they occur
among
elderly,
frail
seniors.
The
cost
of
falls
to
Canadians
isestimated
at
$2.8
billion
annually
(Pub-lic Health
Agencyof Canada,
2005).
Also,
AccreditationCanada
recently
added
'fall
prevention'as one
of
the
newrequiredorganizational
practices for
accreditation
by
Accreditation
Canada.
National collaboration
Recognizing
the
enormouschallenge
facing
seniors,Cedarvale
Terrace
Long-Term
Care
Home in Toronto
de-
cided
to
join
the
National
Collabora-tive
on
FallsPrevention
in
Long-Term
Care Homes.
It
has been
participating
in
this
safetyimprovement
initiative
since
May,
2008.
Upon
joiningthis
initiative,
Cedar-
vale
Terraceset
a
goalto
decreasethe
number
of
falls
among
its
residents
by
25Vo
and
to
reduce
the numberof
injuries
within
six
months.
The
interdisciplinary
team
involved
in this
initiative
embraced
various dis-
ciplines:
medical,nursing,
physio-
therapy,
rehabilitation,
program
man-
agement,
staff
education,
housekeep-ing,
quality
coordinator,
front-line
nurs-
ing
staff
(personalservice
workers
-
PSW
andhealth care
workers
-
HCA),and
management
personnel.
All
fo-
cused
on
safety
for
our
residents.
Through
utilization
of
the
latest
Qual-
ity
Improvement
Model
known
as
Plan-Do-Study-Act,
or
P-D-S-A,
ourteam
was able
to
test
severalfall
prevention interventions.
Improvement
initiatives
TheRNAO
Nursing
BestPractice
Guidelines
for
Prevention
of
Falls
and
Fall
Injuries
in
the
Older
Adult
servedas
a
guiding
tool
of
all
improvement
initiatives
(RNAO.
2005).
Currently,
themedicalteam,
Phar-
macy
and
nursing
are
workingon
fi-
nalizingtheprotocol
to
providevita-min
D
supplementation
for
our
resi-
Volume
20,
Number
3,
Septemberl
October,
2009
II
 
dents.Research
shows
that vitamin
D
is
beneficial
in
falls
prevention
among
elderly
people
(Broe
et
a1.,2007)
Below
is
an
example
of
the
P-D-S-A cycle
for
vitaminD
and
cal-
cium
supplementation
for
implemen-tation
in
the
Cedarvale
facility.
The
P-D-S-A
cycle
The objective
of
the P-D-S-A
cycle
is to
evaluate
the
effectiveness
of
vitamin
D
and
calcium
in
thepreven-
tion
of
falls
among
residents newlyadmitted to
CedarvaleTerrace.
PlanA
review
of
the
research literature
and
evidence regarding the
utilization
of
vitamin
D
and calcium
among
geriatric
patientsand
its
effectiveness
in
the
prevention
of falls
points
to:
.
Vitamin
D
as an emerging
therapy
in
falls
prevention
since
it
improvesmuscle strength
and
function,
.
Combined
use
of vitamin
D
and
cal-cium
has
beenshownto
improve body
sway,
and
reduce
risk
of
hip
and
non-vertebral fracture.
.
Vitamin
D
and Ca supplementation
studies
pointed
to
significantreduction
in
fracture
rates
in
institutionalized
and
community-living
elderly
people.
Do
Introducethe
P-D-S-AQualityIm-provement
Model
to
Physicians
on
the
Falls
Prevention
Team
for
re-
view
and feedback. Supplementation
of
vitamin
D
and calcium
to
newlyadmitted residents
who, upon
assess-
ment, and
deemed
appropriate
by
the
physician
to
receive
this
therapy,
wassuggested. On
the
'to
do'
list:
.
Communicate
the
project
goals
to
newly
admitted
clients
and family.
.
Obtain
consent
for
treatments.
.
Inform
nursing
staffofthe
rationale
for vitaminD
and
calcium.
.
Share information
with
family,SDM,
POA.
.
Utilize vitamin D
and
calcium
uponadmission
(medicationreconciliation).
.
Review
effectiveness
of
the
therapy.
.
Involve
pharmacy
regarding con-
sultations
and
the
setting
of
appro-
priate
dosage.
Study
.
Review
effectiveness
of
vitamin
D
and
calciumandtrack
incidence
of
falls
among
newly
admitted
patients.
.
Track records regarding
critical
in-juries,
i.e.,fractures
due
to falls.
Act
.
Analyze the
results
to
see
if
there
is
a
potential
for
a
wider
application/
utilization
of
the
vitamin
D
andcal-
cium
supplementation
in
the
FallsPrevention
Program.
.
Explore further opportunitiesto
de-
velop
a
LP's Geriatric Guiding
Proto-
col
on
use
ofvitamin D
and
calcium.
Fallsprevention
through
technicalinnovation
1.
Non-removableclipsDescription:
Specialnon-removable
clips
may
be
utilized
with
an
exist-
ing
callbell
system
instead
ofpurchas-
ing
bed alarms.
This
maypotentially
save
hundreds
of
dollars.
This
specially
engineered
clip
has
a
special
lock
between
its
wings
that
preventsunwanted
removal.
Rationale
for
use
.
Regular
clips,
often
removed by
cli-
ents
at
high
risk
for
falls,
are
not
effective
in
falls
prevention
.
Non-removable clips,
once
properly
used
with callbell
systemsand/or
alarms, are
safe
and
will
alwaysalertstaff regarding
safetyconcerns.
.
Cost
of
each
clip
is
approximately
$2.00,
as opposed
tothe
$80.00
-
$100.00
cost
ofa
new alarm unit.
2.
Staffreminders
Use
of
simple
reminders
for
staff,
such
as
a
particularpen
of
a
certain
color, may remindstaff
to
re-check
their
clients
for
safety
while
signing
in
documentation
for
conducted/
scheduled safetytasks.
12
Canadian
Nursing
Home
The
latest
research
developments
in
neuroplasticity show
that
only
a
small
part
of
the
information
that
enters
our
eyes
actually
leads
to
a
consciousawareness.
Oneparticular
finding
shows
adistinction
betweenwhereyou
look
and
whatyou
see.
'S-A-F-Eopractices
Safe
environment.
..
.
At
least
one
bed
rail
down
unless
assessed
otherwise.
.
Pathways
clear
of
clutter.
.
Bed brakes
alwaysapplied.
.
Adequate
and
appropriate
lighting.
Assist with
mobility.
.
.
.
Safe and
regular
toileting.
.
Transfer/mobility
statusadequatelydocumented.
.
Mobility
aids/urinals
within
reach.
Fail
riskreduction
. .
.
.
Callbellwithin
the
client's
reach.
.
Bed
in
lowestposition
for
client.
.
Personal
items
reachable.
.
Proper
footwearavailable.
Engage client
and
family
.
.
.
.
Communicatemutual
plan.
.
Discuss
risk
factors.
Results
This
author
is
pleased
to
report
on
behalf
of
the
Falls
Prevention
Team
that,
in
2008,
there
were
24Vo
fewer
falls
resulting
in
injuries,
compared
to2007.
Further,
and
more
specifically,CedarvaleTerrace
did not
have
any
clients
with
serious
injuries
such
as
hip
fractures.
Most
of
the
falls
re-
sulted
in
no
major injuries
and/or
a
skin
tear
or
bruise. Totalnumber
of
falls
was
reduced
by10.87oin2008.The
challenge
is
to
continue
to
im-proveresident
safety-
without limit-ingtheir mobility
and
independence.
Howfamilies
can
help
Families
can assist
in
safety-relatedchallenges
by
providingproper foot-
wear(i.e.,soft,
without
heels,
non
slip-

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