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Fall Prevention in Nursing Homes Nurse Aid Module Developed by: Duke University Medical Center School of Nursing, Center for Aging and Human Development, and the Durham VA GRECC
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Fall Prevention in Nursing Homes Nursing Team Module
Fall Prevention in Nursing Homes Nurse Aid ModuleDeveloped by: Duke University Medical Center School of Nursing, Center for Aging and Human Development, and the Durham VA GRECC
1Developed: 08-31-092Contact: [email protected] do Nursing Assistants Need to Know about Preventing Falls?By the end of this course you will be able to:
List 3 things that can happen to residents because of falls.Explain what a falls risk factor is, and how to look for it.Describe ways nursing assistants help prevent falls when residents have trouble seeing, trouble walking, or unsafe behaviors. Describe your role in working with co-workers to prevent falls.2
Developed: 08-31-093Contact: [email protected] Focus on Falls?Falls cause serious injuries in older adults.Many falls can be prevented.You can make a difference by understanding:
Why residents in nursing homes fall.What to look for when you are on the unit.How your care helps prevent falls.
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Developed: 08-31-094Contact: [email protected] are falls a problem?Did you know that one-half of the people living in nursing homes fall each year?Did you know that 1 out of 10 falls causes a serious injury, such as a broken bone?Did you know that many falls can be prevented?
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Developed: 08-31-095Contact: [email protected] all residents will fall. To figure out who to watch out for, we look for risk factors.A risk factor is something about a resident that makes it more likely for him or her to fall.The more risk factors a person has, the more likely they are to fall.We can reduce falls by noticing risk factors, and doing something about them.Who is likely to fall?5Developed: 08-31-096Contact: [email protected] fall risk factors can be learned about from past problems.Write down the numbers below that you think are risk factors for falls:
The resident has already had a fall.The resident has had a stroke.The resident cannot see well.The resident has poor memory.What are some risk factors for falls?6AnswersThe resident has already had a fall. Right! A prior fall is the most important risk factor for another.The resident has had a stroke. Yes. Strokes and other kinds of brain problems can cause fallsThe resident cannot see well. Correct. The resident has poor memory. Right. They might do unsafe things because of their poor memory.
7Developed: 08-31-098Contact: [email protected] other risk factors should I look for?Other falls risk factors have to be observed. Do any of the residents you care for:Have incontinence?Become dizzy when standing? Hold onto furniture when walking?Shuffle their feet?Nursing assistants are with residents more than most CLC staff, so you can observe risk factors before anyone else! 88Developed: 08-31-099Contact: [email protected] many falls risk factors do you see? Scenario 1Mr. Jones was admitted today. The charge nurse tells you he had a stroke 2 years ago.After lunch, Mr. Jones says he wants to go back to bed. When he stands up, he complains he is dizzy. He holds onto the dining room chairs as he walks to his room. Write down the number of each falls risk factor you see in Mr. Jones: Holding onto furniture.History of stroke.History of falls.Unsteady walking.Wanting to go to bed after lunch.Being dizzy.9AnswersHolding onto furniture. Good. This is a sign of poor balanceHistory of stroke. Right.History of falls. Falls are an important risk factor, but we dont know that Mr. Jones has had prior falls.Unsteady walking. Yes.Wanting to go to bed after lunch. No, this is not necessarily a risk for falls.Being dizzy. Good. His blood pressure might be dropping, or dizziness might affect his balance.
10Developed: 08-31-0911Contact: [email protected] do we do about fall risk factors when we notice them?Weve just learned that there are a lot of risk factors for falls. But just noticing the risk factors wont keep the resident from falling. We have to do something about them.
Lets take a look at the risk factors that nursing assistants can do something about.11Edited bullet 1changed seen to learnedDeveloped: 08-31-0912Contact: [email protected] Vital Signs (Blood pressure drops)In many older people, blood pressure drops a lot when they sit or stand. This can cause dizziness and falls.Dropping blood pressure is called orthostasis.Dropping blood pressure can be caused by dehydration (not having enough fluids), medicines, or medical problems.You can help identify dropping blood pressure by measuring orthostatic vitals signs.12
Developed: 08-31-0913Contact: [email protected] to Take Orthostatic Vital SignsHave the patient lie down for 5 minutes.Take the patients BP and pulse.Have the patient sit up on the side of the bed with their legs hanging over the edge.Take the BP and pulse again right away.If they can stand up, take the BP and pulse again right away.
Report if you see:A drop in BP more than 20 points, orAn increase in pulse more than 20 beats per minute.13Developed: 08-31-0914Contact: [email protected] nurse asks you to check orthostatics on Mr. Jones. Which is the best way to do it?
Take his BP while he is sitting in his wheelchair, then lie him down and do it again 5 minutes later.Take his BP and pulse after he has been lying down for at least 5 minutes, then elevate the head of his bed and measure BP and pulse again.Take his BP and pulse after he has been lying down for at least 5 minutes, then stand him up and immediately repeat the BP and pulse measurement.Does Mr. Jones blood pressure drop too much? Scenario 214AnswerTake his BP and pulse after he has been lying down for at least 5 minutes, then stand him up and immediately repeat the BP and pulse measurement.
Dont make these common mistakes:Taking the sitting blood pressure firstJust elevating the head of the bed, without letting his or her legs dangle over the side
15Developed: 08-31-0916Contact: [email protected]. Jones BP drops from 160/90 to 125/70 when he stands up. What should you do?
Nothing, it cant be helped.Let the nurse and medical team know, so that they can review his medications and check for other problems.Put compression stockings on Mr. Jones every morning.When you get Mr. Jones up each day, have him sit on the edge of the bed for a few minutes, and provide extra assistance when he stands. Ask the other NAs to do this too. Encourage Mr. Jones to drink plenty of fluids throughout the day.
Should you bother the charge nurse? Scenario 316AnswersNothing, it cant be helped. No!Let the nurse and medical team know, so that they can review his medications and check for other problems. Good.Put compression stockings on Mr. Jones every morning. Great idea.When you get Mr. Jones up each day, have him sit on the edge of the bed for a few minutes, and provide extra assistance when he stands. Ask the other NAs to do this too. Excellent.Encourage Mr. Jones to drink plenty of fluids throughout the day. Right. Dont forget to tell the other NAs who work with Mr. Jones about these ideas too.
17Developed: 08-31-0918Contact: [email protected] Falls Risk Factors: The Nursing Assistants RoleLets think about how nursing assistants can reduce falls for residents who:
Cant see clearly.Have problems moving around safely.Do unsafe things.
18Developed: 08-31-0919Contact: [email protected] on the lights in the bedroom or bathroom, or open up the blinds. Ask the resident if they can see better after you turn on the lights. If not, you may need to adjust the blinds or try different lighting. Keep the residents eyeglasses within reach at all times. You may need to remind the resident to wear their glasses.Let the nurse or medical team know if the resident is seeing poorly, so that they can make sure his eye exam is up to date.How can I help a resident who doesnt see well?19Developed: 08-31-0920Contact: [email protected] can I help a resident who doesnt walk well? Scenario 4Watch Mr. Jones walk by double-clicking the box to the right.Write down at least 2 things you could do to help him.
20Developed: 08-31-0921Contact: [email protected] can I help a resident who doesnt walk well? Mr. Jones walking is not safe because his legs are weak. Here are some things you can do to help him:
Ask if the physical therapist can see him for leg strengthening exercises.Stand by to give him extra assistance when he walks.Adjust the height of his bed, chair, and toilet so that they are knee height or a little higher. 21In bullet 1, it looks like you are sending the NA directly to the PT to request services. Do you intend this or do you want the NA to suggest this to the charge nurse?Developed: 08-31-0922Contact: [email protected] Bed, Chair, and Toilet Height
www.contextualise.com/image/img/Sticktostand.jpg Patients thighs are level when their feet are flat on the floor22Developed: 08-31-0923Contact: [email protected] behaviors often cause residents to fall. Here are some unsafe behaviors you should watch for in Mr. Jones.
He often tries to stand and walk alone.He tries to climb over his bed rails.He walks and paces, even though he seems very tired.He was outside walking alone on rough ground and in the parking lot.
How can I help a resident with unsafe behavior?23Developed: 08-31-0924Contact: [email protected] residents show unsafe behaviors, staff may need to get creative to find ways to reduce falls. Write down 1 creative idea for how you might do the following:
Watch and assist more. Prevent an injury.Make residents more comfortable.
The next slides show some ideas. Was yours on there?
How can I help a resident with unsafe behaviors? Scenario 524Developed: 08-31-0925Contact: [email protected] behaviors:Watch and Assist More Use bed and chair alarms.Take them to the toilet every 2 hours.Take them to activity programs.Keep patient near the nursing station.25Developed: 08-31-0926Contact: [email protected] Behaviors:Prevent an InjuryLower the bed, put down a floor matGet rid of bed side railsPut on non-skid socks or shoesPut non-skid mat on the floorPut on hip protectors26Developed: 08-31-0927Contact: [email protected] Behaviors: Make them More ComfortableReport signs of pain Put them in a recliner or rocking chairTake them for exerciseUse a special mattress, sheepskin, or pillows
27Developed: 08-31-0928Contact: [email protected] Because there are so many fall risk factors, the staff will need to work together to prevent Mr. Jones from falling. Select all the people who might need to do something to keep him from falling.
The nurses assistantsThe direct care nursesThe Rehabilitation staffThe medical teamThe pharmacistHousekeeping and Maintenance ActivitiesPatients and FamiliesRight! Everyone needs to be involved in fall prevention
The Falls Prevention Team28What do nursing assistants do to prevent falls?29Developed: 08-31-0930Contact: [email protected] you want to learn more about preventing fallsTalk to your Facilitys Falls Coordinator or Supervisor about how you can get more involved in fall prevention efforts.
Useful resources:AHRQ innovations site http://www.innovations.ahrq.gov/content.aspx?id=2052Falls Management Programhttp://www.qualitynet.org/dcs/ContentServer?cid=1136495771104&pagename=Medqic/MQTools/ToolTemplate&c=MQTools30Developed: 08-31-0931Contact: [email protected] End
Please close this presentation and begin the quiz.31
