Preventing Falls in the Home

Transcription

1 ~ VOLUME I ISSUE V LESSON PLAN ~ OBJECTIVES Upon completion of this program, the home health aide will be able to:» Identify four variables that increase the likelihood of falls» List three common hazards in the home that may lead to falls, and» Explain the actions to take when a patient falls in the home. OVERVIEW According to multiple studies, falls occur in nearly one-third of all people over the age of 65 and living at home. Among those who fall, half will fall again. A previous fall seems to be a big predictor of the likelihood of future falls. There are many factors that predispose people to falls. These include the use of assistive devices, hazards within the home, chronic illnesses, problems with gait and balance, urinary incontinence, and visual impairments. Most of these factors apply to homecare patients receiving home health aide services, putting them at a higher risk for falling. The Centers for Medicare and Medicaid Services (CMS) reports that homecare agencies must evaluate emergent care for injuries caused by falls or accidents in the home. Homecare agencies are responsible for taking measures to reduce their patients' risk of falling. The topic of falls is important to home health aides for many reasons, including the fact that they typically spend more time in the home than other disciplines. Patients are more likely to demonstrate their normal behavior to the aides, so aides can take the necessary steps to make living areas safer for patients, in addition to reporting problem areas to the nurse and therapist. CONTENT Read the Lesson 20 minutes Read the Case Study 5 minutes Complete "Think About It" 10 minutes Complete the Post-test 15 minutes Feedback Session 10 minutes SUPPLEMENTAL LEARNING ACTIVITIES» Ask a physical therapist to demonstrate the proper way to use several assistive devices. Have participants take turns using the devices.» Download fall prevention checklists and brochures from the National Center for Injury prevention and Control at Discuss experiences you've had with your patients and falls.»review agency policies regarding incident reporting and documentation. Revised 08/23/2013 Page 1 of 6

2 FACTS Falling is a very serious health risk for older patients. One out of every three Americans over the age of 65 falls each year. And at least half of those people will fall again. Because many falls are not reported, it is likely that the number of falls is even higher. Falls are the leading cause of injury-related deaths among older adults, and are the reason behind more than eight out of 10 fractures. Who is at risk for falls? Although any older patient is at risk of falling, certain qualities will increase this risk. These include the following: Key Terms to Aid Your Understanding Assistive device An item that helps a person with activities of daily living, such as a cane, walker, elevated toilet seat, and grab bars. Gait A particular way or manner of moving on foot. Example: An obese patient may have a waddling gait that throws them off balance.» A HISTORY OF FALLS After people fall, they may not move around as much as they did before for fear of falling again. They limit their activities, which can lead to stiffness and poor coordination. Because they are fearful of falling again, they may also make jerky movements instead of walking smoothly. All of these things make them even more likely to fall again.» THE USE OF ASSISTIVE DEVICES You would think that people who use a cane or walker for balance and support would not be as likely to fall. However, many people do not use assistive devices properly. They may have bought them from a pharmacy or borrowed them from a neighbor and were never taught how to use them properly. Or they simply forgot what they learned. Also, when patients borrow or buy devices on their own, they often end up with something that is the wrong size. Assistive devices improperly fitted or used incorrectly actually increase the risk of falls.» DECREASED RANGE OF MOTION AND/OR POOR STRENGTH AND BALANCE Some patients may have diseases that give them poor strength and balance. Spinal deformities from osteoporosis may change the body's center of gravity, causing poor balance. Some very obese people simply do not move around enough to have good balance, and the obesity may give them a "waddling" gait, which throws them off balance. People who have a regular exercise program suited for them are at less risk for falls because the exercise increases range of motion, strength, and balance.» CHRONIC ILLNESSES People with joint diseases, such as arthritis, are at greater risk of falling. Also patients with strokes, lung diseases such as chronic obstructive pulmonary disease (COPD), or heart disease with congestive heart failure (CHF) are much more likely to fall. Having several chronic illnesses increases the risk even more.» TAKING CERTAIN MEDICATIONS OR MANY DIFFERENT MEDICATIONS There are many medications that have side effects that cause problems with balance, stability, or dizziness. Revised 08/23/2013 Page 2 of 6

3 Some of these are medications for hypertension, diabetes, CHF, heard disease, depression, anxiety, and sleep disturbances. These medications, especially when taken in combinations, increase the risk of falls.» PRESENCE OF URINARY URGENCY OR INCONTINENCE Many patients fall because they are trying to get to the bathroom quickly. Some of them fall because they are trying to get out of a wet bed. Others may fall trying to change soiled clothing.» WEARING ONLY SOCKS OR IMPROPER SHOES Often people fall because their footwear is slippery, Some older people wear socks to bed and then forget to put their shoes on when they get up. Or they may wear bedroom slippers with slick soles. All of these may contribute to falling. Hazards in the home increase the risk of falls Hazards in the home increase the risk of falling. Often, patients fall when reaching for an object or while attempting to transfer. These falls could be prevented by some simple measures to make the home safer. More than half of those who fall do so in their own homes due to problem areas, which include the following: Floors: Cluttered arrangement of furniture, loose throw rugs, and objects on the floor such as papers, magazines, books, electrical wires, and even pets Lighting: Inadequate lighting in any area, especially near stairs, bedrooms, or bathrooms Bathrooms: Toilet seat too low, slippery bathtub, no grab bars, no bath chair or bench Stairs: Clutter, broken or uneven steps, loose or broken handrails, torn carpet, light switch out of reach Kitchens: Poor placement of items (things used most often should be closer to waist level), shiny/slippery floors, using chairs as step stools, spills not cleaned up Bedroom: Bed difficult to get into or out of, bedside lamp hard to reach, no night lights While it is true that a nurse or therapist should check the home for these hazards, it is often the home health aide who recognizes the dangers in the home. It is important for aides to assist patients in reducing these hazards as soon as they are discovered. Revised 08/23/2013 Page 3 of 6

4 THE AIDE'S ROLE Patients who become weak or dizzy are generally unsteady on their feet and often fall. Practice proper body mechanics when helping patients stand from a sitting position. This may include using a gait belt for transfers or knowing the patient's specific transfer techniques. Whether you are there to help break the fall or simply witness the fall, or arrive to find the patient already on the floor, follow your agency policy regarding procedures and documentation requirements. When a patient falls If a patient falls while you are in the home, you should:» Follow your agency policies, which usually include the following: First, check to see whether the patient is alert and awake. Call 911 if he or she is non-responsive, and then call the office. If the patient is alert after the fall and complains of pain, particularly in the hip or other joints, do not move the patient. Cover him or her with a blanket, and call the office for directions from the nurse, therapist, or supervisor. If the patient is bleeding or cut, administer appropriate first aid.» Notify the office about the fall even if there does not appear to be an injury.» Document the fall in your visit report along with the following: actions you took, instructions received, the patient's response date and time of the fall patient's pulse presence or lack of consciousness before, dining, or after the fall injuries of any kind, such as broken skin or bumps specific complaints of pain, nausea, feeling tired, dizziness, and any change of appearance.» Complete an incident report according to agency policy. If a patient reports falling when you were not there, you should:» Find out as much as you can about when and how the fall occurred,» Carefully examine the skin for bruises or broken skin.» Report the information about the fall to the office.» In your visit report, document what the patient told you and that you reported the fall by calling the office. Revised 08/23/2013 Page 4 of 6

5 OUTCOMES AND THE HOME HEALTH AIDE CMS Expectations Let s review the basic outcomes, or results, that the Centers for Medicare and Medicaid Services (CMS) looks at to determine whether home health agencies are providing quality care. Your agency has information about your agency s quality of care. Those outcomes are:» How well patients show improvement in Walking Bathing Transferring Managing oral medications Pain that interferes with activity Breathing difficulty, and Urinary incontinence» Fewer hospitalizations» Fewer visits to the emergency department» Patients able to be discharged and remain in the home. Many of your patients are prime candidates for frequent falls due to the medications they take, their age, and their illnesses. But there are things that you as a home health aide can do to prevent falls. Simple actions in your patient s home such as removing loose rugs, improving lighting, rearranging hard-to-reach items, and reminding patients to wear shoes or non-slip house slippers, can greatly reduce your patient s chance of falling. Your patients, as well as your agency, will benefit from and appreciate your careful preparation, planning, and prevention. Revised 08/23/2013 Page 5 of 6

6 CASE STUDY Antoine visits Mr. Otto three times a week. Mr. Otto is 75 years old and had a stroke. He also has congestive heart failure and arthritis, and is taking many different medications. He uses a walker and is a little afraid of ambulating because he fell last summer, even before he had the stroke. Antoine has been seeing Mr. Otto for two months. In that time, Antoine has helped remove a lot of the clutter in Mr. Otto's home. He suggested that Mr. Otto have his son put in better lighting around the house, as well as nightlights in the bedroom and bathroom. The muse arranged for an elevated toilet seat and grab bars to be installed in the bathroom. Antoine helped Mr. Otto rearrange the items in his kitchen so that the things he uses most are not in hard-to-reach places. Antoine always follows the assignment sheet, assisting with range of motion exercises and making certain that Mr. Otto ambulates at least 150 feet every visit. He watches Mr. Otto to make sure he uses his walker every time, and that he uses it correctly. Although the nurse, Antoine, and Mr. Otto have taken measures to reduce the risk of falling, Antoine is aware that Mr. Otto remains at risk because of his medical conditions, age, medications, use of a walker, and his previous fall. Today, Antoine arrives and notices a bruise on Mr. Otto's arm and a small scrape on his hand. He asks Mr. Otto how he got the bruise and scrape. Mr. Otto tells him that he slid to the floor while getting out of bed the other day. Antoine asks Mr. Otto some more questions about the fall and whether he has pain anywhere. Antoine tells Mr. Otto that he needs to let the nurse know about the fall. Mr. Otto asks Antoine not to call the nurse. He says, "I wouldn't have told you about it if I knew you were going to tell; Now my son will want me to move into that assisted living place he's always talking about." Antoine reassures Mr. Otto that nothing about his condition will be shared with his son unless he gives permission. He tells Mr. Otto that it is important for the nurse to know about the fall. After Antoine calls the office and reports the fall, he completes his visit report. "Patient says he slipped while getting out of bed Sunday and slid to the floor Has a dark blue bruise about the size of a quarter above his right elbow, and a small skin scrape on the back of his right hand. No pain. Reported fall to nurse, Sue Jackson, RN." The nurse talks with Mr. Otto's doctor. They decide that physical therapy might help Mr. Otto learn some strengthening exercises. They also plan to develop a new home therapy program for Mr. Otto to follow. Think about it 1. List some of the things Antoine did correctly to prevent falls. Is there anything else he could have done? 2. What would Antoine do differently if Mr. Otto fell while he was there? 3. Did Antoine correctly handle the situation when Mr. Otto asked him not to call the nurse? Why or why not? Revised 08/23/2013 Page 6 of 6