Staff Development Teaching for Preventing Falls in the Elderly Long Term Care Facilities

In the United States, unintentional falls are the most common cause of nonfatal injuries for people older than 65 years. Up to 32 percent of community individuals over the age of 65 fall each year. Females fall more frequently than man in this age group, especially due to the fact that most female elderlies have bone weakness such as osteoporosis, which makes the fall to cause fatal injuries sometimes. Fall related injuries are the most common cause of accidental death in those over the age of 65. Approximately 40 fall related deaths per 100,000 people per year.

Thus, fall are a growing public health problem that need to be addressed. Patient would not only suffer from such fall but the facility goes through hardships as well to deal with the patient. Fall related death rate in elderly group has been increasing in USA. Recently, falling has been occurring a lot in the long-term facilities. Falling has the highest rate of incident in the long-term facility because most of the patients are elderly. Falls can cause serious injuries and accidental death. In order to prevent falls in the elderly is very important.

There are several different approaches to deal with predispose factors for elderly type of injury. I am going to reviews the major risk fators of falls and how to prevention for elderly populations living in long term care facilities. The effective falls intervention programs should take a multifaceted approach.

Assess the staff for ability of learning and understanding

I explained the background of important fall precaution to our licensed nurses and CNAs, the ones who gives care to the patients with ADL most closely. The Staff members, Licensed Nurses, and CNAs have different nationalities with different language. Licensed Nurses are 70% LVN and 30% RN. The experience in the healthcare facility for most of them is at least 3month. Because 90% of staff can fully understand in English, it is not necessary for the educational materials to be in other languages than English. The learners already are familiar with this topic because they already have had experiences in long-term facilities.

How to educate and when is the best time for as much as possible participated in service. In order to prevent further falls, fall precaution presentations will be held during the weekdays in the conference room. Staffs can come in 30 minutes before or after the shift change, and spend an hour on this topic. First, I will show some fall cases through video, so I can induce the staff’s interest in this subject through visualization. Even though the staffs are well aware of the fall incidents, it is not easy to keep an eye on every patient 24/7, which can be frustrating and tiring to the staffs. However, I can explain how much this is important and tell them to try to understand and do the best. I will be identifying what risk factors or what kind of patient has high risks of falling using a current published brochure and video.

What is the cost effect of a fall?

Fall related injuries among elderly are associated with economic costs, which is much greater than the cost to implement a fall prevention program. In the long-term care facilities, even with an interdisciplinary team with physicians, nurses, social worker, physical therapy and administrators, fall prevention is still difficult because there is no way of knowing when one of the patients is going to fall. That is why it is crucial to educate staffs and patients to help reduce these barriers over time. Fall-related injuries account up to 15 percent of re-hospitalizations in the first month after the discharge from hospital. Falls carry staggering economic costs. Annual acute-care costs related to falls are estimated at $1.08 billion and long-term care costs at $4.9 billion.

According to the Centers for Disease Control and Prevention, medical costs related to falls totaled more than $19 billion in 2007–$179 million for fatal falls and $19 billion for nonfatal fall-related injuries. By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion. While falls have a tremendous impact on the patients, they also directly affect a healthcare organization’s cost per case and length of stay. Injuries from falls lead to a 61% increase in patient-care costs. Nearly every nurse can recall an incident in which a patient fell or nearly fell. As patients continue to age and present with increasing vulnerability and comorbidities, their potential for harm increases.

Predisposing factors

Multi-factorial Medications: Lots of medications such as benzodiazepine, tricyclic antidepressant, selective serotonin uptake inhibitors, and trazadone should be identified as high risk for fall. Most elderly long term care residents are reffered to as “polypharmacy” which is high risk for fall. Education (reorientation): fall prevention programs should be reoriented as much as possible call to increase safety awareness and reduces the fear of falling. Environment: frequently check environment that is very important. Web areas, clutter, poor lighting, and other environmental factors can reduce the risk of falling in nursing home.

How to prevent fall

1. After completed fall assessment upon admission, initiate fall precaution as soon as possible. Before appropriate technology and equipment can be chosen to help prevent falls, the patient’s fall risk, functional readiness, and mobility must be assessed. Most of patients consider for high risk for fall. Post-fall assessment is important because a lot of incidents are related to fracture, which is a serious matter. Fall prevention interventions should be assigned that are appropriate for individual based on the result of fall risk assessment

2. Educate patients about predisposing and precipitating factors. This supports them to understand and enable them to do multi-disciplinary approaching. It should be built on initial risk screening results and involve not just nurses but an interdisciplinary team of physicians, pharmacists, and physical and occupational therapists.

3. Educate about basic knowledge of medication to CNA who is closely giving care than others.

Essential implementation of safety caring in long term care facility

1. Transfers: Patients rise from a sitting position to a partial stand to keep the center of gravity relatively low. Transfer the patient to the stronger side with the wheelchair at approximately 45-degree angle from the bed. If patients are unable to bear weight through the lower extremities due to weakness, place one end of the transfer board under the patient between the buttocks and back of the thigh, then place the other end in the seat. Have the patient push up with the arms while slightly lifting the buttocks and slowly moving toward the wheelchair.

2. Get belts: during transfer, obtain a standing position, turn and sit onto another surface or stand and walk to a new location, then turn and sit onto a new surface. The belt is better choice than the alternative placing one arm under the patient’s arm for the lift and holding onto the patient’s clothing or gown, which can injure the arm or shoulder, but care individual need to basic training from PT/OT personal.

3. Bed and toileting safety: height- adjustable beds, safety rails, and raised toilet seats can reduce fall. To promote safety when the patients stands or for transfers, raise the bed. Otherwise, a weak patient who tries to stand could fall. Transfers onto and off a toilet, fix raised toilet seats and safety rails on either side of the toilet are needed. Patients can hold onto these to steady themselves when transitioning from a standing to a sitting position, and to push off from while standing after toileting. If the patient is unable to safely ambulate with assistance to the bathroom, provide a bedside commode.

4. Mobility devices: mobility devices such as canes, walkers, and wheelchair mobility should be made sure that it has been evaluated and deemed approporiate and in a good working order. If it isn’t proper working contact a physical therapist for further evaluation. All mobility devices should be adjusted to the patient’s height and other characteristics as appropriate.

5. Walkers: Nurse can walk next to the patient as the patient ambulates. Walker with seat must lock the brakes when ready to sit or transfer and complete the activity. Patients who become dizzy from nauseas or orthostatic can easily turn and sit on the seat without falling. This arrangement is much safer than having another staff member trail behind with a wheelchair and lower the patient to the wheelchair seat if patient becomes fatigued or dizzy or loses balance.

6. Wheelchairs: individualized wheelchair prescriptions must be customized to each patient because the standard wheelchair does not work for all patients. For example, a dementia patient with memory deficits cannot be expected to remember to lock the wheelchair.

What to do for caring for high risk fall patient

1. Visual check every 2hours or more often
2. Keep bed in low position all the time
3. Lock wheels, call light, water pitcher, urinal in easy to reach.
4. Provide well lit path
5. Check shoes ; check well fitting, floppy shoes or loose clothing
6. Keep room clutter free, floor dry ad not slippery
7. Check bed, wheelchair alarm, or bedside mattress as ordered
8. Promptly answer for need help with call bell system

Evaluation

Verify the education and providing data is effective or not. Throughout this education program, it is important to find a way to help nursing staff deal with issue of patient fall. Staff members recognize how vital it is to be aware of the possibility of fall during care. This program provides gaining more confidence to staff in their abilities to work with care. Even though falls can’t be prevented 100%, applications of fall prevention educations will create a safer, healthier, and happier place for both patients and staffs.