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Preventing High-Risk Slip and Fall Injuries

Preventing High-Risk Slip and Fall Injuries

Preventing High-Risk Slip and Fall Injuries

Author – Cyndi Siders, RN, MSN, CPHRM, DFASHRM, CPPS
Executive Consultant

October 14, 2016

“My Mom is in Good Hands Now”

Mrs. Helga Olson and her son John request an appointment for a tour of your Independent Living/Assisted Living facility. Helga arrives holding on to her son’s arm. She appears to have some pain while walking. Helga has a large bruise on her right cheek and right arm. She tells you proudly that she has just celebrated her 83 birthday. She also tells you that she has lived in her current home for 46 years. Her husband died three years ago and she has been living alone since his death.

You ask Helga if she would like to use a wheelchair for the tour. She gladly agrees and tells you she slipped on some wet leaves while raking outside and she is feeling a bit sore. You casually ask Helga if she has fallen before and she states only a time or two in the last year.

As you are taking the tour, Helga recognizes a few people she knows from community activities. Helga tells you at the end of the tour that she would like more information about the next steps for moving into the facility. Her son John smiles and says, “I am so relieved that you won’t be falling anymore. They will take good care of you.”

older-adult-falls

The Facts…

  • “One in four people 65 and older fall each year.
  • Less than half of the Medicare beneficiaries who fell in the previous year talked to their healthcare provider about it.
  • Every 20 minutes an older adult dies from a fall.
  • 1 out of 5 falls causes a serious injury such as a head trauma or fracture.
  • Almost 2.8 million older adults are treated in emergency departments for nonfatal fall injuries each year.
  • Direct Medicare medical costs for fall injuries total over $31 billion annually. Hospital costs account for two-thirds of the total.”1
  • It is not uncommon for family members to believe that an admission to a senior care facility will protect their family member from falling again.
  • Many seniors and family members are unaware of the risk factors for falling and that the aging process may increase their risk for falls.
  • “Most falls are caused by the interaction of multiple risk factors.” The greater the number of resident risk factors, the greater their chance of falling. Some risk factors are modifiable.2

Clinical team members in senior care are in a unique position to support early recognition of senior fall risk factors. To minimize the risk of falls, care providers should FIRST assess the risk of modifiable risk factors.3

■ Lower body weakness
■ Use of psychoactive medications
■ Postural dizziness
■ Poor vision
■ Difficulties with gait and balance
■ Problems with feet and/or shoes

Source (Adapted From): Centers for Disease Control and Prevention National Center for Injury Prevention and Control. STEADI – Stopping Elderly Accidents, Deaths and Injuries. Risk Factors for Falls. https://www.cdc.gov/steadi/pdf/risk_factors_for_falls-a.pdf (October 12, 2016).

Clinically pertinent assessment of resident risk factors involves assessment and interventions that support identified intrinsic and extrinsic risk factors. 4

Intrinsic Factors
■ Advanced age
■ Previous falls
■ Gait & balance problems
■ Muscle weakness
■ Poor vision
■ Postural hypotension
■ Chronic conditions including arthritis, diabetes, stroke, Parkinson’s, incontinence, dementia
■ Fear of falling
Extrinsic Factors
■ Poorly fitting foot wear
■ Outside walkway with ice and snow
■ Not having eyeglasses, hearing aids
■ Dim lighting or glare
■ Obstacles & tripping hazards
■ Slippery or uneven surfaces
■ Psychoactive medications
■ Improper use of assistive device

Source (Adapted From): Centers for Disease Control and Prevention National Center for Injury Prevention and Control. STEADI – Stopping Elderly Accidents, Deaths and Injuries. Risk Factors for Falls. https://www.cdc.gov/steadi/pdf/risk_factors_for_falls-a.pdf (October 12, 2016).

The News…

news-and-statistics

Boston Globe (January 19, 2016) Death at Wilmington nursing home raises new questions:

“Mary Meuse was all set to visit her family on Christmas. Two days later, the 83-year-old resident of Woodbriar Health Center in Wilmington was dead. A certified nursing assistant using a mechanical lift to move Meuse from her bed to a wheelchair Christmas morning violated a cardinal safety rule, according to a former Woodbriar staffer and a report the nursing home filed with Massachusetts regulators.

Most mechanical lifts require at least two people for safe operation, according to the Food and Drug Administration. But the 21-year-old nursing aide, with no assistance, improperly placed Meuse in the lift, according to the report, and Meuse slipped out, crashed to the ground, and broke both legs. Meuse, who was on blood-thinning medication for heart problems, was not sent to a hospital until the next day. By then, she was bleeding internally. She died in the hospital Dec. 27.” 5

The MetroWest Daily News (May 8, 2016) Watchdog Report: Nursing home care in question after two deaths in Westborough:

“In Central Massachusetts, two deaths last year got regulators’ attention and highlight the need for better care, a Telegram & Gazette investigation has found.

“An 89-year-old Westminster woman with dementia, and a history of falls, died in August 2015, from injuries suffered in a fall at Beaumont Rehabilitation & Skilled Nursing Center in Westborough, after an employee forgot to turn on the alarm on the woman’s chair to notify staff when she got up.

“The following month, another dementia patient at the same Beaumont nursing home died after falling down a flight of stairs in his wheelchair, days after a nurse cut off an electronic tracking system because it was too tight on his leg. A physician had ordered the device.” 6

Kreisman Law Offices. (September 19, 2016). $586,600 Arbitrator Award in Assisted Living Facility Injury and Death Case:

“Violet Moseson, a 97-year-old resident of an assisted living facility, was mandated to be checked on every morning. The facility was to perform safety checks each morning for this resident and others. At the time of this occurrence, the electronic system through which the facility was supposed to communicate with Moseson was not turned on in her apartment when she moved in.

“A week later, Moseson fell in her apartment at night. It was alleged that she spent the next 2-3 days trying to get help. There was a trail of blood and excrement in her apartment when a family member found her lying on the floor. Because of the severity of the fall, Moseson suffered spinal fractures, contusions as well as progressive dementia. Moseson died several months later…” 7

Recommendations for Healthcare Providers…
• Visit the Centers for Disease Control and Prevention, STEADI Stopping Elderly Accidents, Deaths and Injuries website for tools and resources for residents, families and healthcare providers. Some of the available tools include:

■ Algorithm for Fall Risk Assessments and Interventions
■ Safe Medication Review Framework
■ 30-second Chair Stand Test
■ Timed Up and Go (TUG) Test
■ Stay Independent Brochure
■ Risk Factors for Falling
■ 4-Stage Balance Test
■ Measuring Orthostatic Blood Pressure

Source: Centers for Disease Control and Prevention National Center for Injury Prevention and Control. STEADI – Stopping Elderly Accidents, Deaths and Injuries. STEADI Materials for Health Care Providers. https://www.cdc.gov/steadi/materials.html (October 12, 2016).

• Be informed about technology advancements including, but not limited to, motion sensor technology, wireless communications and smart appliances to support senior independence and safety.8
• Ensure a formal process to manage expectations on admission (e.g., admission welcome letter) and during care planning meetings. Include language supporting proactive assessments and interventions for resident safety and partnering relationships. Introduce the concept of Shared Risk Agreements when resident and family choices are not in alignment with recommended care. GuideOne offers the following sample language for a welcome letter or introduction to the facility letter:

While we take all necessary precautions, placement in a nursing home does not guarantee your complete safety. Please ask for help when you need it. Current government reimbursement does not allow us to have one staff member to every resident. On average, nursing assistants are caring for eight to twelve other residents. As a result, you may not always be in the direct line of sight of a staff member, and you may have to wait for short periods of time for assistance. It is our goal to answer your call light as quickly as possible. Staff also has been trained to anticipate resident needs whenever feasible.

Just as at home, falls and accidents happen, even with someone in immediate attendance. As people age, bones and legs become weaker, vision declines, and balance becomes a problem. This normal process of aging can increase the likelihood for a fall and fracture. (Facility Name) frequently assesses and reassesses fall risk factors and employs many devices that reduce the likelihood of an incident, but unfortunately they still can occur. Working together, we can minimize the risk of falls and accidents.

(Facility Name) cannot claim to insulate you from the risks associated with normal living, the consequences of your choices, or make the world perfect just inside our door. We will work hard to protect you, but ultimately your preferences must be honored, even if some of those choices could be harmful. It is up to you to define your quality of life. If there are times when your choices are not the same as the physician, your family, or the staff of (Facility Name), we will respect that. However, as health care providers, it is still our obligation to point out the consequences of your choices. We can’t be responsible when your choices result in negative outcomes.9

• Perform a formal falls risk assessment including intrinsic and extrinsic factors on resident admission, re-admission from hospital or other inpatient stay, after an emergency room visit, quarterly, with significant changes in condition and immediately following a fall. Ensure interventions support the level of identified risk. Consider new admissions, with risk factors, as high-risk for falls for a designated period of time (e.g., 72 hours or until acclimated to their surroundings).
• Ensure complete documentation of resident falls including assessments, monitoring, interventions, changes to the care plan, communication and documentation. Continue post-fall monitoring and documentation for 72 hours or until resolution of any injuries.
• Establish a structured communication process for transfers and handoffs that includes fall risk and fall risk interventions.
• Review professional recommendations for flooring as part of a proactive risk management business plan for new construction and remodeling projects. One author suggests the following – “Flooring in high-traffic areas — including lobbies, hallways, dining areas and restrooms should be:

o Flat and smooth to eliminate trip hazards, facilitate walking with a cane or walker, and provide low resistance to wheelchairs
o Slip-resistant to prevent falls
o Cushioned to reduce impact in the event of a fall
o Monochromatic or have simple, non-contrasting patterns and a low-glare finish so as not to confuse those with impaired vision or depth perception
o Impervious to water and other spills
o Easy to care for
o Health and sustainable”10

• Prepare for winter flooring hazards including rain, ice, sleet and snow.

o Consider the impact of salt that is tracked in on shoes and boots on the cleaning and waxing products that are used on floors.
o Consider microfiber mops for more controlled moisture management on flooring.
o Consider using four to eight foot walk-off mats in entrances and exits for adequate moisture, snow and salt removal.
o Maintain outdoor recreation spaces. Review professional resources for the recommended usage/combination of sand and salt.11

This blog entry includes links to external website not associated with Vaaler Insurance, Inc. or its affiliates. When you link to another website, you are no longer on the Vaaler website or subject to the Vaaler Privacy Policy. However, you will be subject to the privacy policy of the new website that you are visiting. Vaaler and its affiliates do not endorse any information or services that these external sites offer, and only provides the links as a service to you.

This blog, which does not reflect any official policy or opinion for Vaaler Insurance, Inc. or Siders Healthcare Consulting, LLC, is provided for informational purposes only. It is not intended to provide legal or medical advice, nor is it intended to be an exhaustive list of all risks that need to be addressed for a healthcare organization. While every effort is made to provide accurate information, changes may occur and inaccuracies happen despite best efforts. This information is not a substitute for individual consultations with professionals in these areas and should not be relied on as such. Please work with your legal counsel and business advisor(s) for a plan that is specific to your organization. © 2016 Vaaler Insurance, Inc.

Sources:
1. Centers for Disease Control and Prevention National Center for Injury Prevention and Control. STEADI – Stopping Elderly Accidents, Deaths and Injuries. Falls are a Major Threat for Your Patients. https://www.cdc.gov/steadi/pdf/steadi_falls_
major_threat_1in4-a.pdf (October 12, 2016).
2. Centers for Disease Control and Prevention National Center for Injury Prevention and Control. STEADI – Stopping Elderly Accidents, Deaths and Injuries. Risk Factors for Falls. https://www.cdc.gov/steadi/pdf/risk_factors_for_falls-a.pdf (October 12, 2016).
3. Ibid.
4. Ibid.
5. Lazar, K. Boston Globe (January 19, 2016). Death at Wilmington nursing home raises new questions. https://www.bostonglobe.com/metro
/2016/01/18/death-resident-after-nursing-home-accident-raises-new-concerns-about-company/opPd0TMprgB21WN8Wmd6ZI/story.html. (October 13, 2016)
6. Thompson, E. The MetroWest Daily News (May 8, 2016). Watchdog Report: Nursing home care in question after two deaths in Westborough. http://www.metrowestdailynews.com/news/20160508/watchdog-report-nursing-home-care-in-question-after-two-deaths-in-westborough. (October 13, 2016)
7. Kreisman, R. Kreisman Law Offices. (September 19, 2016). $586,600 Arbitrator Award in Assisted Living Facility Injury and Death Case. http://www.robertkreisman.com/nursing-home-lawyer/category/nursing-home-fall-cases/. (October 13, 2016)
8. Sollito, M. Aging Care.Com. Technology for Elderly Enhances Health, Safety. https://www.agingcare.com/Articles/techology-for-elderly-living-at-home-147427.htm. (October 13, 2016)
9. GuideOne Admission Letter. http://www.goriskresources.com/NursingFacilities/Resources/index.htm. (October 13, 2016)
10. Chotiner, M. McKnight’s (September 16, 2016). Vinyl flooring prescription for facilities. http://www.mcknights.com/marketplace/vinyl-flooring-prescription-for-facilities/article/523281/. (October 13, 2016)
11. Brown, J. Long-Term Living (January 7, 2015). 4 ways to manage slip-and-fall safety. http://www.ltlmagazine.com/article/4-ways-manage-slip-and-fall-safety. (October 13, 2016)

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