Knowledge Assignment: Fall Prevention
Mrs. L is an 89-year-old widow who lives independently in her home. Although Mrs. L does not currently take any medications, she has gone through other medical conditions that put her at risk of fall. The medical conditions that put her at risk for fall are Bilateral hip replacements, Detached retina × 2 (right eye), Osteoarthritis, Depression, Orthostatic hypotension, Falls at home × 1, Urinary frequency, and Insomnia (sleeps about 3 hours per night).
Since Mrs. L was admitted to the hospital, it is the nurses’ responsibility to do a comprehensive assessment of the patient and implement the appropriate care plan. According to The Hendrich II Fall Risk Model, the patient scores 11, which means a high risk for falls (Hendrich, 2016). In The Pittsburgh Sleep Quality Index (PSQI), Mrs. L scored 17 with a range of 0-21 points, “0” indicating no difficulty and “21” indicating severe difficulty in all areas (Buysse et al., 1989), which put her at a high risk of losing balance and falling. Another fall indicator was her Mini-Cog screening for cognitive impairment. Mrs. L scored 2 out of 5, which means she is experiencing dementia, which is also an important contributor to falls (Borson, n.d.).
To implement safety goals for Mrs. L in the Environmental and equipment category, we need to make sure that her room is clean and all the wires are tacked away from her walkway. Also, emphasizing using a call light during the hospital stay is important. Regarding gait and mobility, we should encourage the patient to use a walker and wear her non-skidding socks all time. Moreover, when the patient is prescribed new medications, especially for geriatric dementia patients, we need to emphasize using a daily pill box that organizes the medications for each day to avoid forgetting or overdosing. We need to help patients in practicing relaxation techniques such as applied relaxation, progressive muscle relaxation, cue controlled relaxation; mindful breathing; biofeedback) to reduce their depression and anxiety.
Borson, S. (n.d.) Mini-Cog screening for cognitive impairment in older adults. Retrieved from https://mini-cog.com/
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index (PSQI). Retrieved from http://www.sleep.pitt.edu/research/ewExternalFiles/PSQI%20Instrument.pdf
Hendrich, A. (2016). Fall risk assessment for older adults: The Hendrich II Fall Risk model. Try This, 8. Retrieved from https://consultgeri.org/try-this/general-assessment/issue-8.pdf
Development of a Fall Prevention Program Sample
Patient Falls are sentinel events in nursing facilities that result in adverse health effects, including prolonged hospitalization, increased cost of care, injuries, disabilities, and mortality. According to the Agency for Healthcare Research and Quality (AHRQ, 2017), approximately half of 1.6 million residents in US nursing facilities endure the consequences of physiological and accidental falls.
Further, AHRQ (2017) states that one out of ten falls in the country’s nursing facilities results in serious injuries annually, including hip fractures that reduce the quality of life, decrease the ability to function, and compromise patients’ ability to complete daily activities. Although patients of demographic diversities are susceptible to accidental and physiological falls, older adults are more vulnerable to such sentinel events due to physical frailty, deteriorating health, and underlying age-related health conditions. Therefore, this paper elaborates on a case study of patient falls and presents a fall prevention program for an American nursing home.
A Story About a Patient
McDonald is an 87-year-old male resident of St. Monica’s Senior Living facility in Racine, Wisconsin. Before enrolling in the assisted living facility, McDonald’s family grappled with the daunting task of managing his deteriorating memory and cognition following a diagnosis of mild to moderate dementia symptoms. His wife, Elizabeth (84), relied massively upon social support systems and help from her children to monitor McDonald’s activities, including medication adherence, activities for daily living, and social interactions.
However, five years after receiving a dementia diagnosis, he exhibited mild and moderate cognitive and memory decline, prompting Elizabeth and his family to contact St. Monica nursing home. The nursing home provides various individualized care services to patients with all forms of dementia, including medication coordination, memory care, assisted living, physical therapy, and life engagement, rendering it ideal for improving McDonald’s health.
Although enrolling McDonald in St. Monica nursing home was a sigh of relief to his family due to their comprehensive care, his physical frailty and underlying age-related conditions increased his susceptibility to sentinel events such as falls. The nurse revealed McDonald’s history of tolerating various medications for regulating dementia symptoms, including galantamine and rivastigmine. While considering his medical history, caregivers became more cautious about medication administration practices and the potential consequences of pharmacologic interventions.
Undoubtedly, observing medication administration precautions proved effective in eliminating medication errors and averting adverse effects of inconsistent medical outcomes. However, McDonald fell off his bed after a 2-week stay in the nursing home. The primary risk factors for that incident were intrinsic considerations such as unsafe behaviors, balance and strength deterioration, and deconditioning from inactivity.
After McDonald’s fall, nurses and physicians conducted physical examinations to determine the extent or presence of injuries. They confirmed that he was aware but had suffered a hip fracture. Therefore, caregivers collaborated with emergency medical services and transferred the patient to the hospital. Further, they coordinated care to ensure faster recovery and patient satisfaction.
Developing a Fall Prevention Program for St. Monica Nursing Home
The McDonald’s case study provides insights into individual factors that increase patients’ susceptibility to sentinel events such as falls, especially in healthcare facilities providing care to people with cognitive impairments and memory deterioration. According to Cameron et al. (2018), cognitive impairment and dementia are intrinsic factors that increase patients’ susceptibility to increased risk of falls.
Also, physiological and physical frailty correlates to increased vulnerability if appropriate external and organizational support is lacking. Apart from intrinsic factors for patient falls, extrinsic causative and contributing factors such as environmental hazards, unsafe equipment, and unsafe use of personal care items can lead to accidental falls (AHRQ, 2017). Therefore, a practical fall prevention program for the nursing home entails two primary tenets: preventing and responding to patient falls.
Preventing Patient Falls
While providing care to patients struggling with cognitive impairment and dementia poses a challenge to healthcare professionals, a fall prevention program should encourage risk identification as the primary intervention for preventing future incidences. According to Christy (2017), intrinsic factors such as delirium or dementia and organizational issues like poor lighting, cluttered spaces, unstable furniture, wet floors, and inadequate staffing increase the likelihood of patient falls. As a result, caregivers should identify these risks by conducting root-cause analysis (RCA), implementing timely rounding protocols, and evaluating contextual issues that facilitate sentinel events.
Apart from risk assessment, evidence-based practices such as environmental modifications, physical restraints, patient education, and non-slip socks are fundamental interventions for preventing patient falls. According to LeLaurin & Shorr (2019), environmental transformations include introducing visual cues, setting rooms for high-risk patients, and eliminating trip hazards. On the other hand, physical restraints present the “last resort” alternatives for protecting patients from failing by restricting their movements. Nursing homes should consider these physical safeguards because they enable organizations to implement contextual fall prevention measures.
Institutional management should initiate policies that entail quality improvement to prevent patient falls. Some administrative strategies for protecting patients from failing include staff education, establishing clinical checklists, and using technologies such as automated alarms and wearable devices to improve patient safety. LeLaurin & Schorr (2019) argue that alarm systems can reduce falls by alerting caregivers when patients attempt to leave their beds or chairs without assistance. On the other hand, patient education increases individual awareness and assists patients in self-managing their fall risks (Heng et al., 2020). St. Monica Nursing Home should consider implementing these interventions to guarantee patient safety by eliminating sentinel events.
Response to Patient Falls
Although it is essential to prevent falls, they are sometimes accidental and unanticipated. In this sense, the only viable option to safeguard patient safety is embracing appropriate response interventions to assess injuries, administer medications, implement referrals, and monitor patients’ progress. According to the Agency for Healthcare Research and Quality (AHRQ, 2017), an effective program for responding to falls incorporates various steps, including evaluating and monitoring patients, investigating circumstances, recording findings, and developing immediate interventions.
Immediate approaches for safeguarding patient safety are care coordination, alerting primary care providers, and referring patients to emergency departments for comprehensive and timely care. Other responses to patient falls are care plan development, fall assessment, implementing improvement initiatives, and evaluating resident responses and caregivers’ adherence to new guidelines (AHRQ, 2017). Undoubtedly, these measures require leadership commitment, interdisciplinary collaboration, regular evaluation of staff safety performance, and proper documentation of safety data and trends.
Patient falls result in adverse effects such as lengthy hospitalization, mortality, increased care costs, and compromised quality of life. Since patient falls pose a multifaceted challenge to healthcare organizations, especially those delivering care to older adults with cognitive impairment and dementia, McDonald’s story provides insights into various interventions for protecting patients from falling. In this sense, a fall prevention program such two primary tenets: preventing and responding to incidences. These components anchor evidence-based interventions such as care coordination, eliminating environmental hazards, patient and staff education, interdisciplinary collaboration, risk assessments, and developing a safety culture.
Agency for Healthcare Research and Quality. (2017, December). The falls management program: A quality improvement initiative for nursing facilities. https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man1.html#
Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and Hospitals. Cochrane Database of Systematic Reviews, 1–328. https://doi.org/10.1002/14651858.cd005465.pub4
Christy, R. (2017). Preventing falls in hospitalized older adults. Nursing, 47(7), 1–3. https://doi.org/10.1097/01.nurse.0000520711.64646.28
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1–12. https://doi.org/10.1186/s12877-020-01515-w
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007