Contact: Kevin Kavanaugh
Director of Public Affairs
(773) 478-6613
kkavanaugh@nursinghome.org


March 8, 2000

Illinois Nursing Homes Take the Lead in Reducing Falls

 (Chicago) -- The Keiser Institute on Aging has released a report that found that prevention methods can profoundly reduce the risk of falling for the elderly, although fall risk assessments are not widely administered to help prevent "first" falls. While many community seniors do not utilize risk assessments to reduce their risk of falling, Illinois nursing facilities have taken the lead in instituting fall prevention programs that have been successful in reducing falls and increasing residents’ feelings of security, independence and well-being.

An estimated 10 to 17 million people over 65 are expected to fall in 2000 and 30 percent will experience moderate to severe injuries as a result. Because of the life-threatening dangers of falls, the Keiser Institute on Aging has designated March 6-10 as Fall Prevention Week. Over 1,000 senior centers, retirement communities, and nursing homes across the United States are sponsoring a variety of activities this week to increase awareness and access to vital assessment and fall prevention information.

The Illinois nursing home industry has worked very hard to address the issue of fall prevention in promoting resident safety and independence. In September of 1997, the Illinois Council on Long Term Care, a health care association representing over 200 nursing facilities serving 35,000 Illinois nursing home residents, sent its member facilities a standardized fall protocol developed by industry experts. This policy was developed in cooperation with the Illinois Department of Public Health and recommended the following interventions:

        Fall Risk Assessment on every resident -- As part of the Council protocol, every resident admitted into a nursing facility receives a comprehensive fall risk assessment that uncovers factors and combinations of factors that need to be addressed on the resident care plan. This assessment is over and above what is required by federal and state regulations.

        Fall Investigation -- Every time a resident falls, staff members complete a Fall Investigation Report that assesses the details of the fall, causes of the fall, contributing internal factors (medical conditions) and contributing external factors (such as medications, appliances, and environmental circumstances). The Fall Investigation Report is used to determine whether additional or modified care plan interventions are warranted because of the most recent fall.

        Incident Report for Resident Falls with Injury -- An Incident Report is completed in conjunction with the Fall Investigation Report when the fall of the resident also resulted in an injury, including bruises and skin tears.

The Council Fall Protocol has been adopted by many Illinois nursing facilities and demonstrates a good faith effort on the part of these facilities to reduce and prevent falls.

The issue of fall prevention has currently received a great deal of attention from both nursing home providers and public health surveyors due to the successful efforts of nursing homes to reduce restraints. As of December of 1999, the restraint rate in Illinois nursing homes is 6.9% (nationally, the restraint rate is 12.09%). This rate is a dramatic decrease from the year 1988, when 41% of residents nationwide were in restraints.

A by-product to restraint reduction, however, has been an increased risk of non-serious falls.

In response to this possibility of increased falls, Illinois nursing homes have implemented fall prevention programs that involve every staff member in the facility. The fall prevention programs at Illinois nursing facilities include the following components:

 

    A multidisciplinary safety committee to develop and implement an institution-wide fall prevention program. The members are knowledgeable in the area of falls and include one or more persons (e.g. Director of Nursing, Medical Director, Rehab Director, Director of Quality Assurance, etc.) who has the administrative authority to enact or facilitate policy change. The safety committee evaluates the facility environment overall for potential fall risks.

     An in-service nursing and medical house-staff education program for all professionals involved in resident care on the cause of falls, factors responsible for fall risk, and appropriate preventive strategies. Nursing education extends to staff on all three shifts.

        A mechanism to identify residents at fall risk immediately upon admission and available for each nursing shift. Fall risk is reassessed whenever an individual’s medical condition, medication regimen and mobility status changes. Identification tags (i.e. colored wrist identification bands, colored adhesive stickers near the bedroom door and bedside, on medical/nursing charts, etc.) are used to alert staff to high-risk persons.

   Residents are assessed immediately after a fall; they are evaluated for underlying medical and environmental causes. A formal program and policy for reporting and investigating incident reports is in place.

   Strategies are implemented to prevent falls, and follow-up occurs on a regular basis to review whether the designed interventions have decreased falls. The success of a facility’s fall prevention program is regularly assessed during the facility’s quality improvement meetings.

Because there are so many factors that can lead to falls, such as vision impairments, dizziness, mobility problems, medications, and cognitive deficits, preventing falls can be quite challenging. “We look at many factors when assessing falls,” states Diania Magafus, RN, nurse consultant for Dynamic Healthcare. “Our interdisciplinary team evaluates if we have done everything that possibly we can to adequately identify risk factors and treat the residents. Sometimes it’s hard to pinpoint exactly what led to a resident falling.”

Oftentimes, the best interventions for preventing falls come directly from the front-line staff. “Our nurse aides, housekeepers, activity assistants, and other front-line staff members know our residents the best,” points out Donna Sprinkle, MS, Quality Assurance Director of ManagCare. “We solicit the advice of these staff members in developing creative fall interventions. They often have the best ideas of successful ways that we can reduce falls for each individual resident’s unique circumstances.”

Among the strategies that have been proven successful in reducing resident falls at Illinois nursing homes have been:

   Identifying residents at high risk for falling, including those having poor vision, gait disturbances, weakness, cardiovascular disease, incontinence, and a history of falls.

   Increasing the sensitivity of the entire staff to the potential for accidents within and around the facility through ongoing education programs. Instructing each employee to play a part in noticing, reporting, and reducing potential hazards.

   Teaching residents safe transfer techniques from bed, chairs, toilet, and wheelchairs. Advising residents to change positions slowly, holding on to a stable object as they do.

    Utilizing exercise as a means of improving resident strength, balance, and coordination.

    Encouraging volunteers and family members to assist with the monitoring of residents at risk for falls.

   Having the facility therapist evaluate residents for interventions such as physical therapy, restorative programs, and adaptive equipment such as positioning cushions or tilted seats.

    Monitoring medications; in particular minimizing the use of sedatives and tranquilizers.

    Encouraging residents to use handrails.

    Placing residents at risk for falling in rooms near the nurse’s station for easier observation.

   Continuously assessing for environmental hazards and eliminating as appropriate. Keeping floors free from litter and clutter. Providing good lighting in all resident areas. Cleaning spills immediately. Maintaining beds at their lowest position and keeping bed wheels locked at all times. Using a low profile bed if needed.

   Assuring that residents use canes, walkers, and wheelchairs only when prescribed and that these aids are fitted to the individual and are used correctly. Making sure to check these mobility aids regularly to ensure they are in good repair, as broken equipment can cause injury.

   Making sure that residents wear well-fitted, low-heeled shoes; preventing them from wearing long robes and pants that fall below the ankle.

One of the most important components of the fall prevention programs at Illinois nursing homes is reviewing individual cases of resident falls and examining trends during quality improvement meetings. “Our safety committee carefully looks at the statistics -- number of falls, time of the day for falls, staffing patterns, locations of falls -- to draw accurate conclusions about how we can enhance resident safety,” states Barb Lupo, RN, Nurse Consultant for Family Care Management. “Preventing falls requires a proactive approach whereby staff members are continuously scrutinizing various risk factors for falls and developing solutions as part of a team approach to care.”

Through the development of fall prevention programs, Illinois nursing facilities have been very successful in enhancing resident safety, independence, and outlook. As Terry Sullivan, executive director of the Illinois Council on Long Term Care, explains, “Preventing falls is a very serious challenge that impacts not only on residents’ physical well-being, but also affects their emotional status as well. Threats of impending falls can alter a resident’s self-image and create feelings of frailty and incompetence. Staff members at Illinois nursing homes have focused on the issue of fall prevention in their continuing efforts to maximize resident wellness and quality of life.”

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