Fall Risk Factors
Environment
Interventions
Medications
Misc.
100
What is the strongest predictor of a future fall?
What is a previous fall/history of falls. We are working on better communication with everyone for those that are a high fall risk.
100
Where do most falls occur in our facility.
Where is resident room. If a resident is in their room, please keep their door open as they allow. If they prefer it closed, frequent checks need to be completed.
100
What are the leaves outside of residents doors for?
Falling Leaf - indicates that a resident is a high fall risk.
100
What type of medication increases urination?
What is a diuretic - being on diuretic increases fall risk because a resident may need to frequently use the bathroom or have incontinence. If a resident becomes dehydrated, their blood pressure will drop, they may be unsteady and fall.
100
True or False: You find a resident that is known to put themselves on the floor. They are care planned for this; is it still considered a fall?
True: Per CMS guidelines "unless there is evidence suggesting otherwise, when a resident is found on the floor, a fall is considered to occur." We need to witness a resident placing themselves on the floor for it to NOT be a fall.
200
What is the diagnosis when your blood pressure drops when you stand?
What is orthostatic hypotension. Orthostasis occurs when you stand and you get dizzy/lightheaded and your BP drops. This is very common in the elderly. Contributing factors: medications, dehydration, age, neurological disorders, endocrine disorders (low thyroid or uncontrolled DM)
Best practice is to stay with a resident after standing to ensure they are steady and able to ambulate on their own. Hypotension can last a few minutes.
200
True or False: Keeping the bed in the lowest position for someone that can transfer is best practice.
False - this is considered a restraint.
200
What program is currently in action to help prevent falls that you fill out an entry form?
What is a good catch entry.
Forms are located at both nurses' stations. All are encouraged to participate!
200
True or False: Taking anticoagulant medications increases your risk for internal bleeding if you fall. If a resident hits their head d/t a fall, should you update the provider?
True - We currently have one resident that is on coumadin. We have a few residents that are on Eliquis (apixaban) and Xarelto (rivaroxaban) and Plavix. Many residents are also on ASA which can lead to internal bleeding.
200
True or False: If a resident has a fall with a major injury (fracture, closed head injuries, internal bleeding and death) you don't need to file an OHFC report.
False: Per CMS, "facilities should review incident management systems and ensure timely report and root cause analysis (RCA). You need to report to OHFC for all major injuries.
***If you suspect a fracture or major injury, file a report! We can speak to it later if there was not a major injury. We have 2 hours to report from the incident***
300
Sam had a right sided stroke. What side of the body does this affect and what are some symptoms that may occur that can contribute to a fall?
What is the left side. A stroke with affect the opposite side of the body depending on what side of the brain was affected. Right sided stroke will affect the left side of the brain: weakness on the left side, vision problems, quick and impulsive behavior, left side neglect or inattention, and memory loss. All of these increase the risk for a fall.
If someone has a left sided stroke the following characteristics may be seen paralyzed right side, speech and language deficits, slow, cautious behavior style and memory deficits.
300
What should you do with gripper socks that have no grip left?
What is throw them away.
300
Walking your unit regularly is called what?
Frequent rounding - staff should be assessing residents at least every hour to ensure safety. It would be best to check more often when they are in bed or in their rooms and a known fall risk.
300
True or False: Mr. Doe didn't receive his 1100 dose of Sinemet for his Parkinson's Disease. Missing this medication will not affect his balance or gait.
What is False: Sinemet must be administered as prescribed on time. Sinemet helps to treat tremors, stiffness and muscle control.
300
A resident can still propel themselves in their w/c, but they continue to fall out of their chair. What would it be called to put them in a rock-n-go w/c and make them rely of staff for transportation.
What is a restraint. It is our job to allow a resident to be able to live up to their full independence. It is also our job to check on them more frequently knowing that they are a fall risk when in their standard w/c. This is the residents right.
400
Risk factors related to surroundings.
What are environmental hazards.
Fall mats, black nonskid mats, wheelchair across the room vs next to the bed, cords, papers that have fallen on the floor.
400
A resident is refusing to wear hipster pants, what do you need to fill out?
What is a risk benefit. Residents have the right to refuse cares/interventions, but we need to ensure that we are provided proper education as to why the intervention was recommended.
400
True or False: Care plans should be tailored to the individual.
True - Each resident is their own person, and our care plans need to reflect that. What works for one resident might not work for another. This is patient centered care.
400
Medications such as Seroquel and Zyprexa are this type of medication.
What are psychotropics. Psychotropics greatly increase the risk of falls in the elderly and possible death.
400
Who is responsible for preventing falls and ensuring resident safety?
Who is everyone! It doesn't matter what your position is in this building, if you see an unsafe situation that may result in a fall, it is your responsibility to keep them safe and find the help as needed.
500
Joe Smith is a diabetic and he Parkinson's. He can't feel his feet. What is this diagnosis?
What is neuropathy. Neuropathy is a neurological disorder that can cause loss of feeling in distal extremities. Someone with this diagnosis is at increased risk for a fall. Imagine your foot is asleep and you try to stand on it.
500
When a resident is not in their room, what level should the bed be left at?
What is transferable height.
You never know when another resident may go into a room and try to get into bed. If the bed is left too high or too low, it greatly increases the risk of falls.
500
What are the 4 P's of reducing the risk of falls?
What is Pain, Positioning, Potty and Personal Possessions.
500
What is the definition when you take several medications each day, often defined as five or more.
What is polypharmacy. We review residents medications regularly with our contracted pharmacist to ensure that the residents are not over medicated. Taking multiple medications increases the risk of falls d/t the side effects
500
Where is the best place to find what safety interventions are in place for a resident?
Where is the Kardex. Each resident has a Kardex hanging in their room, usually in their closet. You can also find them in POC/PCC, or there are blue binders at each nurse's station.
600
What contributed to this fall?
What are stairs, improper footwear, vision concern - glasses fell off
600
True or False: It is 0400 and still dark outside. Residents are awake in the common areas on Evergreen. It is best practice to keep the lights dim.
False: It is best to have adequate light. As we age, our vision worsens and we need more light to see.
600
What is the meeting called that occurs after a fall?
What is IDT (Interdisciplinary Team). M-F at 0930, there is a meeting in the Sunporch to discuss falls/incidents. EVERYONE is welcome to join to share ideas and come up with new interventions.
600
What are some risks with taking bowel medications that may increase the risk of falls?
What is an electrolyte imbalance, dehydration and urgency.
Some laxatives, especially stimulant types, can cause dehydration and electrolyte disturbances, which are more dangerous in older adults with reduced kidney function. Bowel meds are mostly administered on day shift in hopes they pass a BM before NOC shift. Senna can be given in the evening, so it has more time work while at rest.
600
John Doe can transfer in and out of bed on his own but rolls out of bed frequently. Are fall mats appropriate for this resident?
What is no, fall mats are raised due to the padding and can cause more falls by tripping. It is best to leave doors open and frequently round on residents that are in bed.
700
When is a resident most at risk for a fall?
When is within 24-48 hours of admission. Build up their care plan at admission. Prevention is best. Make sure you are rounding on them frequently, communicating what you are seeing and let the nurse know to update the care plan.
700
With the new flooring on Evergreen, what was resolved between the dining room and living room?
What is the threshold. When there is a drastic change in color/texture on the floor, many dementia residents don't understand and think they are going to fall into a black hole, so they try to step over it, causing falls. All the flooring in the building will be replaced.
700
What do the HSTs fill out every shift for communication?
What is the IDT 24-hour board. Night shift HSTs start the board. This board continues to be updated throughout the day. They are located at the HST stations. All departments are encouraged to review them, so you know what is happening.
700
This drug, often used for moderate to severe pain, can cause dizziness and balance issues.
What are narcotics - Narcotics are a very strong pain medication with many side effects that can lead to falls. Most of our resident are "opiate naive" and have a more sedating effect vs someone that has a tolerance.
700
Staff from birch and evergreen meet one day a month for what?
What is a household meeting. These meetings include all departments from the household to discuss what is happening on the household, how can they make things better for themselves and the residents. Even if you do not work that household regularly, you are expected to attend. All ideas are good ideas. Fresh eyes see what others may not.