Falls Management

1. PURPOSE:

 1.1 To improve and maintain a patient’s optimal functional level and quality of life
 1.2 To identify and reduce or eliminate environmental risk factors for IHHC clients
 1.3 To identify and reduce or eliminate health risk factors for patient.
 1.4 To reduce the frequency of falls
 1.5 To reduce the severity of injuries from falls
 1.6 To ensure best practice interventions for patient who have fallen
 1.7 To monitor and track trends related to patient falls

2. POLICY:

 2.1 It is the policy of IHHC to provide the highest quality care in the safest environment for the patients
   receiving home care.
 2.2 IHHC program identifies the factors that place residents at risk for falls, promotes proactive
 2.3 Health care practices for patient care planning using the least restrictive method possible to keep the
   patient safe and identifies the main components of an effective fall prevention program. These
   components include fall risk assessment, identifying risk factors, implementing interventions,
   documentation, evaluation, regular reassessment and re-evaluation.
 2.4 The home shall ensure that a falls interdisciplinary prevention and management program will
   bemaintained to reduce the incidence of falls and the risk of injury to the resident and promote resident
   independence.

3. DEFINITION:

 3.1 A fall - is any unintentional change in position where the resident ends up on the floor, ground or other
   lower level.
   3.1.1 Includes witnessed and un-witnessed falls
   3.1.2 Includes if resident falls onto a mattress placed on the floor
   3.1.3 Includes whether there is an injury or not.
 3.2 A near fall/near miss - is a sudden loss of balance that does not result in a fall or other injury. This can
   include a person who slips or trips that does not result in a fall or other injury. This can include a person
   who slips, stumbles or trips but is able to regain control prior to falling.
 3.3 An un-witnessed fall - occurs when a resident is found on the floor and neither the resident nor anyone
   else knows how he or she got there.
 3.4 Serious Injury includes - fractures, laceration-requiring sutures, and any injury requiring assessment in
   Emergency or admission to the hospital.

4. PROCEDURE:

 4.1 Staff: Registered Nurse
   4.1.1 Collaborate with family to conduct the fall risk assessment within 24 hours of admission
   4.1.2 When a change in health status puts them at increased risk for falling such as:
      4.1.2.1 Falls in 72 hours
      4.1.2.2 More than 3 falls in 3 months
      4.1.2.3 More than 5 falls in 6 months
      4.1.2.4 Significant change in health status
      4.1.2.5 Falls resulting in serious injury
   4.1.3 Should determine the patient’s level of risk as Low or High. Any risk should be care planned and
   treated.
   4.1.4 Initiate a written plan of care within 24 hours of admission based on patients assessed condition,
   fall history, needs, behaviors, medications and preferences using the Interventions/Strategies to Reduce
   the Risk of Falls.
   4.1.5 Continue to update the care plan based on the assessment and complete the care plan within
   7 days after admission.
   4.1.6 Report the incident to the Senior/Junior Charge Nurses based on their level of risk and/or as
   deemed appropriate and initiates strategies/activities to reduce/minimize the risk of falls (e.g. to
   Physiotherapy for assessment).
   4.1.7 Assess for and implement nursing restorative/rehabilitation activities as part of care Planning
   4.1.8 Monitor and evaluate the care plan at least quarterly in collaboration with the other medical team.
   If the interventions have not been effective in reducing falls, initiate alternativeapproaches and update
   as necessary.
 4.2 Fall and Post Fall Assessment and Management:
   4.2.1 When a patient has fallen, the he/she will be assessed regarding the nature of the fall and
   associated consequences, the cause of the fall and the post fall care management needs.
 4.3 Person witnessing the fall or finding the resident after the fall:
   4.3.1 Assess the environment, before mobilizing the resident, for clues as to objects which may have
   struck the resident during the fall or caused the fall.
   4.3.2 Do not move the resident if there is suspicion or evidence of injury until a full head to toe
   assessment has been conducted and appropriate action determined. (e.g. transfer to hospital).
   4.3.3 Notify the Senior/Junior Charge Nurses.
 4.4 Documentation:
   4.4.1 Date and time of the incident
   4.4.2 Location of the incident
   4.4.3 Whether the fall was witnessed or un-witnessed, status of the resident (e.g. type and severity of
   injury, if any) which assessments were completed and outcome of the assessment.
   4.4.4 Who was notified of the falls probable cause of the fall, resident outcomes and interventions taken
   to prevent further falls or related injury
   4.4.5 If the resident was sent to the hospital
 4.5 Staff Training and Education:
   4.5.1 Staff Orientation:
      4.5.1.1 Provide orientation and training on the falls prevention and management program (policy,
      procedures, tools) including the importance of the program and the risk to residents’ health due
      to falls.
      4.5.1.2 Review the falls prevention and management program training annually.

5. RESPONSIBILITY

 5.1 IHHC Staff
   5.1.1 To ensure safety measures are being observed at all times
   5.1.2 Closely Supervise and never leave patient’s bedside
   5.1.3 Encourage patient’s participation and involvement in preventing fall incidents
   5.1.4 Complete documentation
 5.2 IHHC Management
   5.2.1 Investigation of the incident
   5.2.2 Ensure completeness of the report and action taken

6. APPENDICES – see IHHC FALL RISK ASSESSMENT TOOL

7. REFERENCES:

 7.1 McWilliams, James R. RN, MSN (February, 2011) An Evidence-Based Pediatric Fall Risk Assessment
   Tool for Home Health Practice. Volume 29. Issue 2 p 98-105