Interdisciplinary Fall Prevention Considerations - Synchrony

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Interdisciplinary Fall Prevention Considerations

Preventing and addressing falls to keep our residents safe is a team effort.  It is crucial for the IDT to understand risk factors, examine root causes, and employ preventative measures to decrease falls in our campus.  Please look over the following list of considerations.

Fall Risks Prior to Admission or Immediately Upon Admission

  • Note history of falls
    • During hospitalization
    • Within the last year
  • Note documented fear of falling or patient reported worry about falling
  • Note weight-bearing status
  • Anticipated level of assistance needed for transfers and ambulation
  • Note previous or recommended assistive device such as cane, walker, wheelchair, etc., or any prosthetics
  • Note possible contributing diagnoses
    • Cardiac dysfunction
    • Hyper-/hypo-tension
    • Syncope, vertigo, reports of dizziness
    • Seizures
    • Dementia
    • Head, neck, or back injury that decreased range of motion
    • Parkinson’s disease
    • CVA, hemiparesis
    • Joint surgery
    • Incontinence
    • Neuropathy (especially in lower extremities)
    • Pain
  • Note number of current medications (polypharmacy)
    • Pay special attention to diuretics, anti-hypertensive, psychotropic, benzodiazepines, sedatives, antidepressants, or anything that may alter cognitive status
  • Note current documented cognitive status (flag confusion, agitation, decreased orientation, dementia, anxiety, depression, exit seeking, etc.)
  • Note documented or reported vision or hearing impairments
  • Note functional communication status
  • Input from family

Considerations After a Fall

  • Time and location
  • Environmental set-up at time of fall
    • Was resident in an unfamiliar environment
    • Preventable environmental barriers (also was adaptive equipment available)
  • Associated medical conditions (as noted above)
  • Footwear status and overall foot health (pressure areas, edema, pain, numbness, etc.)
  • Cognitive status
  • Recent medication changes
  • Positioning considerations
    • Pressure relief
    • Biomechanical issues
    • Inability to reposition self comfortably
  • Missing glasses or hearing aids
  • Communication status
  • Nutrition and Hydration status
  • Activity status (lack of activity, frequent boredom, etc.)
  • Report from resident (as able)

Preventing Falls

  • Monitor changes in status
    • General health, including continence
    • New diagnoses
    • Medication changes
    • Mobility/balance
    • Transfer/lift status
    • Cognition
    • Nutrition/Hydration
    • Activity
    • Pain
  • Routine checks to ensure basic needs are met
    • Call light in reach and answered timely
    • Adaptive equipment within reach
    • Common items within easy reach (TV remote, tissues, reacher, phone)
    • Toileting schedule
    • Non-slip footwear in place
    • Comfortable to environmental temperature (not too cold or hot)
    • Comfortable when sitting in wheelchair; reduce sliding
    • Assist with frequent position changes as needed
    • Snacks offered; maintain hydration
    • Encourage Life Enrichment participation to reduce boredom
    • Continued education regarding current transfer and ambulation status to resident, family, and staff
  • Routine environmental checks
    • Clean up spills
    • Adequate lighting
    • Bed height; sheets not tangled
    • Remove obstacles/hazards
    • Room set up appropriately to manage hemiparesis
    • Adaptive equipment in good, working condition (wheelchair breaks lock/unlock easily, leg rests swing away/appropriate height, back/head rest, etc.)
  • Refer to Therapy for screening