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by Rein Tideiksaar, PhD
Fall prevention in nursing homes and hospitals is an ongoing process.
The goal of any fall prevention is to achieve 'good outcomes' (i.e., a reduction in falls and injury). The ability to prevent falls and injury is dependent upon having in place a standard process of care, which includes assessing the risk of falls, implementing multidisciplinary interventions designed to reduce risk, monitoring patients/residents 'at-risk' and evaluating falling episodes.
In essence, the process represents the clinical framework of fall prevention. Having in place an organized approach or process of care to preventing falls and injury will help staff identify factors contributing to falls and fall risk and finding solutions to reducing the risk of falling and injury.
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Steps
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Action |
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Assessing Fall Risk
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- The main purpose of risk assessment is to identify those patients/residents most likely to fall. The rationale for a risk assessment is that if patients/residents at high fall risk can be identified, then appropriate strategies can be instituted to reduce risk.
- Baseline fall risk assessments should be completed upon admission (within 2 hours of admission).
- Reassessment of fall risk needs to be ongoing; completed whenever patients/residents experience a change of condition or medication, daily/every shift in certain high risk patients/residents (e.g., recent confusion, taking sedatives, recent fall, temporary acute illness, etc.), and immediately post-fall.
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Multidisciplinary Evaluation
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- Following risk assessment, an attempt should be made to identify the cause(s) of all risk factors identified. Since most patients/ residents will have multiple risk factors, multidisciplinary referral and evaluation is necessary.
- The risk assessment and subsequent multidisciplinary evaluations serve as the basis for selection of fall/injury risk reduction strategies
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Care Planning
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- A fall prevention program is only useful if there is also an effective treatment or strategy available to reduce risk.
- For those patients/residents "at-risk", strategies (e.g., medical, nursing, rehabilitative and environmental interventions) needed to be targeted towards identified risk factors.
- It's important to remember that as risk factors change, strategies may have to change as well.
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Post-Fall Assessment
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- All patients/residents who fall should receive a post-fall assessment. The purpose of this assessment is to discover what caused the fall and to prevent another fall from occurring.
- Key components of the post fall assessment include: identifying all internal and/or external factors contributing to the fall and identifying the presence of any new or additional risk factors. This information is very helpful in conducting an analysis of the fall (i.e., asking, "What happened?" and "Why did it happen?"), and designing appropriate strategies to prevent further falls.
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| Posted May 2010 |
