Safety Status – Fall Risk, Elopement Risk, Skin Integrity Risk, Infections

Fall Risk

Risk Management Strategies

  • Fall Reduction Interventions – Each resident has intrinsic (e.g., medications, health conditions, cognition) and extrinsic risk factors (e.g., mobility devices, condition of glasses) that potentially increase their risk for a fall injury.

  • Complete a fall risk assessment on admission, change in condition, change in medications, readmission, and after a return from an emergency room visit. Recognizing changes in mobility is an essential observation for minimizing the risk of falling for residents.

  • Implement appropriate safety interventions, including resident and family preference (as appropriate), and monitor the effectiveness of these interventions.

  • Consider a “5 Why” approach when investigating/analyzing the contributing factors of resident falls (note more than 5 why’s may be necessary depending on the situation). Example:

    • Why did the resident fall out of the chair? – (S)he was reaching for something

    • Why was (S)he reaching for something? – (S)he was reaching to pick up a bug

    • Why was (s)he reaching to pick up a bug? – We believe (s)he was hallucinating.

    • Why was (s)he hallucinating? – We think it is related to a new medication (s)he was started on.

    • Why was (s)he started on a new medication? – For a urinary tract infection.

    • Why does (s)he have a urinary tract infection – One potential cause is that (s)has been drinking less fluids.

    • Why having (s)he been drinking less fluid? etc.

    • Please note there may be a number of contributing factors for one resident fall including change in resident condition.

Skin Integrity Risk

Risk Management Strategies

  • Skin Injury/Integrity – During the aging process physical changes occur, such as loss of skin elasticity, thinning of the skin, and loss of normal sensation. All of these changes may contribute to skin concerns, including bruising, skin tears, or other more serious wounds like pressure ulcers.

  • Complete a formal skin assessment on admission, readmission, change in condition, significant change in medications, and at least quarterly.

  • Implement appropriate interventions to minimize skin injury risk. Ask the resident and family what has worked in the past to maintain healthy skin (e.g., lotions, hydration, wearing long sleeves, lighting at night to avoid bumping into furniture).

  • Observe skin condition with daily cares and bathing. Require – Early Recognition, Reporting and Response

  • Evaluate physician orders for healing effectiveness. Involve outside agencies as appropriate for care and treatment of skin injuries and pressure ulcers.

Elopement Risk

Risk Management Strategies

  • Elopement Prevention – Resident safety is a fundamental right and expectation of every resident and family member. We have all read the stories of the senior that walked away from their senior living community and was found frozen in the snow or the senior that drowned in a pond.

    • Complete wandering and elopement assessments on admission, readmission, and change in condition.

    • Implement appropriate interventions to minimize wandering and elopement risks. Be vigilant in monitoring effectiveness.

    • If resident safety can not be managed at the facility, be proactive in working with the family for placement at another facility.

Daily Safety Status

Risk Management Strategies

  • Monitor Daily Safety Needs/Status – Require a safety update at each shift report (e.g., wandering, restless, not using their safety equipment, confusion, aggression, talking about going somewhere – home, to work, etc.)

Infection Prevention

Risk Management Strategies

  • Infection Prevention – In the elderly, infections may present with symptoms that include loss of appetite, dehydration, weakness, and confusion. Common infections in the elderly include but are not limited to: urinary tract infections; skin infections (e.g., herpes zoster – shingles, bacterial or fungal foot infections, cellulitis, and drug-resistant infections like MRSA); bacterial pneumonia; influenza; and gastrointestinal infections.

    • Implement proactive measures to minimize infection risk: including handwashing, personal protective equipment, appropriate cleaning protocols, visitor restrictions during periods of infection risk, and resident and family education.

(Source A Place for Mom.  Senior Living Blog. The 5 Most Common Infections in the Elderly. http://www.aplaceformom.com/blog/2013-10-22-common-elderly-infections/)

  • Purposeful Rounding – Consider a formal process for “Purposeful Rounding” including ongoing care team safety awareness and communication

    • Pain: Assess the resident’s pain level. Provide pain medicine if needed

    • Personal Needs: Offer help using the toilet; offer hydration, offer nutrition, empty commodes/urinals

    • Position: Help the resident get into a comfortable position

    • Placement: Make sure resident’s essential needs (call light, phone, reading material, toileting equipment, etc.) are within easy reach

    • Prevent Injuries: Actively involve the resident/family (as appropriate) in safety awareness and communication about concerns. Frequently remind residents about safety interventions.

Source – Agency for HealthCare Research and Quality.  Fall Prevention Tool Kit.