Risk Factors
True or False: a client who has previously fallen before may experience a higher risk of falling again.
TRUE
True or False: a resident/patient, Power of Attorney, or their Substitute Decision Maker should not be involved in their individualized care plan
FALSE
True or False: The Apotex and Hospital Falls Prevention Policy are the same and can be used interchangeably
FALSE
True or False: near-miss and unwitnessed falls require SERS reports, even when there is no injury
TRUE
History of fall(s), nutritional deficiencies, incontinence, sudden changes in blood pressure and impaired vision are WHAT kind of fall risk factor?
Intrinsic/biological risk factors
Staff can look at and understand a client's specific fall risks and their support needs in the client's individualized:
Hospital - Fall Prevention Care Plan
Apotex - Fall Care Plan
What are three different positions that can be used to take orthostatic blood pressure for a client with a potential fall risk?
1) After lying down for 5 minutes, 2) After sitting for two minutes, 3) After standing after 2 minutes
Name 3 potential assistive devices or equipment that a client might need (looking for specific equipment rather than type of device)
Mobility aids and walking supports (walkers, canes), fall detection devices or monitoring technology (fall alerts, bed/chair alarms), fall prevention clothing (hip protectors, grip socks), bathroom safety equipment (grab bars, shower chairs, raised toilet seats)
Define fall, assisted fall, and unwitnessed fall
Fall - any unintentional change in position where the client ends up on the floor, group, or other level
Assisted fall - any unintentional change in position where the client ends up on the floor, group, or other lower level as assisted by another person
Unwitnessed fall - occurs when the fall is not observed by another person and the client is found on the floor, ground, or other lower level
When you are in a common area or in a non in-patient care area and you see a fall, what are the first few steps you should take?
1) Do NOT move the person, 2) Stay with the person, 3) Call ext. 5555 for a medical alert
What are three side effects of medications that might increase a person's fall risk?
1) Dizziness or Faintness, 2) Drowsiness, 3) Confusion, 4) Sudden Blood Pressure Changes, 5) Blurred Vision, 6) Difficulty with Balance
An interdisciplinary/interprofessional team approach to fall prevention and management can include... name at least 4 potential professions at Baycrest that could be part of this team.
1) Pharmacist, 2) Occupational Therapist, 3) Physiotherapist, 4) Recreational Therapist, 5) Doctor, 6) Registered Nursing Staff, 7) Dietician, 8) Personal Support Worker
After a fall, these are some of the things that staff responsible for providing care for a client should do - name 3.
1) look for contributing factors and inform the person inform the person completing the post falls assessment, 2) make sure that the care plan is updated and review any changes, 3) routinely monitor the resident and report any changes to the relevant staff, 4) ensure that appropriate referrals are made to the relevant profession, 5) have a designate inform family/POA/SDM, 6) notify the physician or Most Responsible Practitioner
List 4 different environmental/situational fall risk factors:
1) Poor lighting, 2) uneven surfaces, 3) slippery floors, 4) inappropriate footwear or clothing, 5) improperly maintained or used assistive devices, 6) low toilet seat, 7) no grab bar, 8) prolonged hospital stay, 9) unsafe transferring, 10) restraints
Name 5 prevention strategies that clinical staff should consider for a patient. Hint: FALL SAFE
F = Functional Status and Footwear, A = Ambulation and Assistive Devices, L = Lighting, Layout, & Environment, L = Low Bed, Locked Brakes, & Alarms, S = Sensory, Cognition, & Communication, A = Alerting Mechanisms & Education, F/E = Fluids, Elimination, & Medical Factors
A client at Baycrest must have a Falls Risk Assessment completed based on certain conditions:
Hospital: 1) within 24 hours of admission or 2) 24 hours post-transfer to another unit, 3) after a fall, 4) every 3 months or sooner if clinically necessary
Apotex: 1) within 24 hours of admission or re-admission from Hospital, 2) as triggered by the MDS Resident Assessment Protocol, 3) a significant change in status
The emergency primary survey for witnessing a fall includes:
A = airway and alertness (with c-spine protection), B = Breathing and ventilation, C = circulation and hemorrhage control, D = disability (neurologic status), E = exposure and environmental control