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Catch a Falling Star

August 1, 2001
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Isabella Geriatric Center created a team program and handy new form to reduce resident falls by Yaffa Ungar, PT
The Isabella Geriatric Center has mounted a multifaceted attack on resident falls
BY YAFFA UNGAR, PT The staff at Isabella Geriatric Center has always been strongly committed to the reduction of falls among our residents. We strive to provide a safe environment while continuing with our successful efforts to remain "restraint-free." A specialized Fall Prevention Committee was formally established in 1997, whose mission is the reduction of falls through a systematic, multidisciplinary team approach. Members of the committee include representatives from nursing, administration, medicine, rehabilitation, security, maintenance, environmental services and pharmacy. A very successful "falling star" identification program was initiated in 1997 to identify those residents at high risk for falls. A colorful "falling star" sticker is placed over the bed and on the side of the wheelchair and/or assistive device of any resident identified by the interdisciplinary team as high risk. This program serves as an alert to all staff, including clinical (medical, nursing, rehabilitation, dietary and social service) as well as housekeeping, laundry, maintenance and clerical staff. The colorful star is a signal to observe the resident closely and to intervene if the resident displays any unsafe behaviors (e.g., getting up from his/her wheelchair without the necessary assist). All staff are regularly in-serviced on this program on a departmental level and during the semi-annual facility-wide mandatory education programs.The environmental services and maintenance departments continue with their weekly rounds to ensure environmental safety. These rounds ensure that there is proper lighting throughout the facility, that the beds are in good working condition (including the brakes), that there are no water-spillage problems, and that all the flooring, baseboards and handrails are secure and intact. Early on, the floor wax was changed to a slip-resistant product.

Most recently, the members of the Fall Prevention Committee custom-designed a fall risk assessment tool with associated protocols tailored to our geriatric population (Figure). This tool lists 12 major fall risk factors, with a point value assigned to each factor. If the total score is between 3 and 7 points, Fall Prevention Protocol I is initiated (Table 1). If the score ranges between 8 and 16, the more aggressive Fall Prevention Protocol II begins (Table 2). If five falls occur within 60 days, a special team meeting is scheduled. This fall risk assessment tool is applied by the nurse to all admissions and readmissions and upon a resident's fall. Our interdisciplinary team has reported that the tool heightens its awareness to the level of fall risk. The carefully designed protocols delineate many interventions available for fall prevention. Protocol I includes such choices as reinforcing use of the call bell, adjusting the bed to its lowest position, rehabilitation screens, medication reviews, and education of resident and family.

Protocol II interventions include initiation of falling star identification, use of chair and/or bed alarms, use of low beds, wheelchair seating alternatives, use of protective equipment (helmet, hip pads), half-hourly resident checks and room changes. Any intervention is implemented immediately and documented in the resident care plan. Isabella's management information services (MIS) department helped with the design of a specialized database for the collection of all accident/incident data, including falls. This database assists staff in identifying any trends regarding falls. Parameters that are tracked include:

'time of fall/shift
'location of fall/unit
'location and type of any resulting injury
'treatments administered and referrals made
Table 1. Fall Prevention Protocol I.

  1. Fequently reorient and repetitively reinforce use of call bell and ensure it is within reach.

  2. Reassess for a clutter-free, well-lit environment.

  3. Consider adjusting bed to its loweest position.

  4. Reinforce use of assistive devices, if used.

  5. Reassess for safe footwear.

  6. Monitor use of eyeglasses and hearing aid, if applicable.

  7. Consider rehabilitation screen, if appropriate.

  8. Institute bowel/bladder routine program, as appropriate.

  9. Conduct a medication review.

  10. Evaluate the need for an adjustment in resident's daily activity schedule.

  11. Educate resident's family/significant other regarding these interventions and encourage family assistance and support.

Table 2. Fall Prevention Protocol II.

  1. Initiate falling star identification.

  2. Implement chair or bed alarm, as appropriate.

  3. Implement low bed, as apropriate.

  4. Implement wheelchair seating alternatives (wedge cushion, reclining chaire; contact OT Dept.), as needed.

  5. Implement use of protective equipment (helmets, hip pads), as indicated.

  6. Initiate half-hour/hourly checks and/or placement of resident at nursing station, as needed.

  7. Consider room change.