How many older adults have fallen in your facility this year?
Falls aren’t a pleasant thing to think about. But if you’re involved in operating a residential care home, thinking about them is a big part of your job.
You probably know the statistics. But they most certainly bear repeating, so here’s a reminder.
According to a figure from the American Centre for Disease Control, an average nursing home with 100 beds reports 100 – 200 falls per year.
Here in Canada, half of all older adults in long-term care facilities fall each year.
You understand the scope of the problem. You have a fall prevention plan in place, and it meets the necessary standards. But you’re sure you could be doing more.
There are areas where improvement is always possible. For example, your interdisciplinary team should continually strive to better understand how risk factors for falls work together.
That said, if you’re trying to evaluate your facility’s approach with an objective eye, getting back to basics is essential.
The following questions area good place to start.
Is Your Fall Prevention Plan Data Driven?
Is your fall prevention plan fully informed by relevant internal and external data?
Best practices are far from static. It’s true that outside bodies play an important role in deciding which practices should be adopted. But that shouldn’t dissuade those responsible for your facility’s fall prevention plan from accumulating new knowledge.
Ultimately, your people are the ones with firsthand experience of your facility. They can connect research findings to past and ongoing events. And doing so is worthwhile. Sometimes, what the research uncovers is very significant.
Consider what happened when researchers assessed footage of falls from two B.C. care homes. A study of 130 people provided new insight into how falls occur in long-term care settings.
Assessing data from your own facility is also critical. The footage in the study above just happens to have widespread significance. But it may also have uncovered risk factors directly related to the environment in which it was collected. (For example, video can point towards physical hazards, such as subtle lighting issues).
The population of your care home is unique, as is its staff. Only through the internal collection and analyses of your data can you uncover patterns rooted in variables specific to your facility. This information can help you make necessary adjustments to your fall prevention plan.
In many cases, cameras are appropriate – though they usually only capture incidents that occur in specific areas. When it comes to surveilling high-risk residents, privacy issues may come into play.
For these reasons, video only tells part of the story. Fortunately, when it comes to certain types of data, it is possible to see the complete picture.
With the right technology, you can capture the exact response time for every fall in your facility. It’s also possible to log details – such as the staff members that responded to each incident – automatically.
This type of information is extremely useful because it’s actionable – and critical.
The performance of staff members as it relates to falling incidents may lead to management action that saves lives.
In sum, those in charge of assessing falls shouldn’t limit themselves when they collect and review data. While keeping variables constant, they should remember that discoveries start with the recognition of patterns.
Is it Truly Inclusive?
The importance of an interdisciplinary approach to fall prevention is well known. But in addition to drawing on a large pool of knowledge, your fall prevention plan should be inclusive.
By inclusive, this is what we mean: every staff member who interacts with residents should play a meaningful role in fall prevention.
The personal support workers (PSWs) on your staff know the protocol for transferring high-risk residents. But can you confidently say that they know which resident complaints might point to a future fall?
In many cases, mild discomfort and impatience appear routine. Without the right knowledge, it’s easy to miss subtle signs that a dangerous situation is about to occur. Add several residents who need care at the same time to the mix, and prioritization mistakes are bound to happen.
Urinary incontinence is an often-overlooked risk factor for falling. Is every employee who spends time with residents aware of this fact?
Urinary tract infections (UTIs) can pose similar risks. Of, course, UTIs aren’t always detected immediately in older adults, even by the most vigilant caretakers.
Do all of your PSWs know how to watch for less obvious symptoms? Do they know that an undiagnosed UTI can increase falling risk?
If your answers to all of these questions is “yes”, you’re ahead of some facilities in terms of general awareness.
The bottom line is, staff members want to help residents avoid falling. Your facility’s fall prevention plan should go beyond training and universal recommendations. Those who oversee fall prevention should try to observe and issue relevant reminders to staff.
We all know educational measures need to be implemented and updated. It’s when they’re tailored to your environment that major positive change occurs.
Is it Responsive?
No fall prevention plan would be complete without emergency response and post-fall management protocols.
Dealing with falls is, no doubt, a huge priority for your facility. But it’s easy to forget carefully-laid plans when an emergency occurs. The fact that (sadly) unreported falls still occur in some care homes attests to this fact.
Keeping staff as informed as possible is critical. To use a cliche phrase, knowledge is power. For those who work with care facility residents, knowledge extends beyond best practices.
It goes without saying that everyone on staff should be crystal clear when it comes to understanding their basic responsibilities. In the event of a fall, certain information (how to report, who to contact, etc.) should be second nature.
In addition, at any given time, on-duty staff should be able to identify frequent fallers. They should also have a basic understanding of resident fall histories. Does the person who just fell need to be monitored for a specific period of time?
These may seem like very basic concerns, but all too often, they’re forgotten over time – and in the heat of the moment.
When it comes to improving response times, technology is key. You’re probably aware that there are a lot of solutions on the market. But you may be surprised at just how different these systems can be.
If resident falls are a major ongoing problem, you could be using a technology that addresses the wrong issues. Look for features related to the biggest fall-related problems in your facility.
Say, for example, prioritization is difficult for your staff. Attendant nurses and PSWs can’t be everywhere at once. How can those who are on-duty assess more than one situation at the same time – without resorting to the invasion of privacy that comes with 24 hour surveillance?
In this type of situation, an innovative solution is best. You might, for example, consider in-room video technology that’s only activated when a fall occurs.
Product research based on specific requirements will lead to far better results.
The Bottom Line
When it comes to building an effective fall prevention plan, a holistic, resident-centred approach is key. For many health care and caregiving professionals – including those in management positions – this is easy to remember.
Why? Because you care about your residents. You see them, first and foremost, as people.
But when you’re considering whether your fall prevention plan will help those under your care in the long run, don’t forget about basic logistics.
How well informed is your staff when it comes to developments in fall prevention? And do they understand the elements of your plan – including actions they may have to take – clearly and completely? If you’re at all unsure, it’s time to sit down and take stock.
Feature Image: sima dimitric