- Is this a Nursing Home, SNF, Hospital, etc.? Select: Nursing Home.
- Name of Facility: Miami Nursing Home.
- Name of Falls Program: Reducing Falls through Improved Communication and Kinesiotherapy.
Falls are among the more common causes of injury in older adults, and the reason is that a variety of issues and conditions may cause them. Pfortmueller, Lindner, and Exadaktylos (2014) list reasons relevant to long-term care institutions such as sarcopenia or frailty, impaired senses, multimorbidity, vitamin D deficiency, and polypharmacy. All of these concerns require specific measures that address them without creating further complications. However, only some of them can be answered through quality improvement initiatives without the need for prohibitively high investments.
Interventions can reduce the severity of issues such as deficiency in vitamin D, sarcopenia, and polypharmacy. The first problem can be answered by increasing the patients’ vitamin D intake if it is determined to be insufficient. Frailty can be reduced through exercise programs such as balance or strength training, according to Pfortmueller et al. (2014). Lastly, careful consideration of the necessary medication and reduction of the intake where possible contribute significantly to addressing issues related to polypharmacy, although the problems are likely impossible to eliminate.
The environment, particularly floors that may be slippery and make a patient’s feet slide, sometimes causes falls. However, redesigning the entire interior of a nursing home to remove the possibility of slipping is an expensive and challenging task that would result in new complications in areas other than falls. According to Quigley (2015), the nursing home should provide patients with appropriate footwear at all times.
Patients should wear nonskid socks in their day-to-day activities to prevent slipping and put on well-fitting shoes for ambulation. However, in cases where a person has a shuffling gait or foot drop, he or she should avoid wearing nonskid socks, as they may facilitate stumbling.
Nevertheless, the implementation of specific environment-related measures that help patients prevent their falls is possible without a need for high spending. Among such measures are stationary standing and walking aids, such as bed rails. Bed rails are sometimes considered to be restraints by the patients, and therefore the approach is not appropriate for everyone. However, according to Moore, Ryan, and Rhead (2015), patients who request the aids or are unable to leave the bed on their own are less likely to view the objects as restrictive, and medical specialists are obligated to have the patient’s best interests in mind when dealing with people without decision-making capability.
Moore et al. (2015) note that neither the elimination nor routine use of bed rails is an appropriate care intervention, and the decision on the use of the aids should be made for each patient separately. Despite the negative connotations, bed rails are a valid fall prevention method and should be used when necessary.
Patients often disregard the probability of falls, which leads them to follow the nursing home fall prevention guidelines less closely. Wolf and Hignett (2015) note that assuming that bad things happen to other people is a part of human nature, and a significant portion of the participants in their study displayed that attitude. However, interventions that specifically deal with the prevention of falls and not the minimization of injury caused by them become significantly less effective if the nursing home cannot ensure the commitment and full participation of the patients. Therefore, improved communication and education about the risks and consequences of falls is necessary to improve the success rate of other interventions.
The key to securing the cooperation of the patients lies in satisfying their need for control of their lives. Wolf and Hignett (2015) note that patients want to determine whether and when they need assistance as well as the type of help. They also want information that is presented in an appropriate fashion and on demand. Wolf and Hignett (2015) propose the use of a Participatory Ergonomics framework to eliminate the disconnect between nurses and patients and improve communication. The patient should become a willing critical stakeholder in the system, which will give him or her a perception of control and make him or her more willing to collaborate, as he or she will feel that he or she receives clear benefits from the partnership.
Nevertheless, complete elimination of falls in nursing homes is not possible to achieve with current methods and technology. Fall incidents will still occur, and some of them will result in injury for the victims. People who have had a fall accident already should be considered a separate group with a higher risk of repeated mishaps, as they are generally in poorer health due to the injury. Fear of falling is also a significant contributor to the likelihood of repeated accidents, according to Paris et al. (2016). Seniors who have been in fall incidents before require particular interventions that are primarily intended to reduce the negative consequences of their injuries and help them overcome their insecurities.
Kinesiotherapy is an effective method for the rehabilitation of seniors who have suffered fall-related hip fractures. Paris et al. (2016) propose a program that consists of a warm-up, stretches, resistance exercises, extensions, balance training, and other activities. According to their results, the therapy results in immediate improvement in the health of the participants that remains in effect 12 months after the initial exercise program. Furthermore, the literature review by Paris et al. (2016) shows that physical therapy has a positive influence on the physical and mental health of the patients who have suffered a fall previously. As such, kinesiotherapy is a practical approach to improving the health of patients with a history of falling and should be incorporated as an intervention.
The staff will require expertise and education in specific competencies before the interventions can be put into practice. The nutrition and medicine intake of the patients should be left to specialists, but most medical workers can be trained in conducting exercises and communication. The latter requires particular attention, as the staff members need to learn about the Participatory Ergonomics framework and its application to their specific situation, such as patient engagement methods and appropriate practices.
The implementation of some of the interventions listed above will require the nursing home to maintain a stock of items needed for the activities. In particular, it will be necessary to store nonskid socks and footwear for each patient and have some bed rails, preferably a set for each bed in the home. Other activities, such as exercise, may also benefit from the use of specific training aids. If the patients like having necessary information presented to them in a form they can access at will and do not suffer from sight impairments, it may be prudent to create informational brochures for them to read.
A single patient will require approximately ten pairs of socks, two or three pairs of footwear, and a bed rail to be stocked by the care facility. Assuming prices of $10 for a couple of nonskid socks, $100 for a pair of hospital-appropriate shoes (if the patient’s family does not provide appropriate footwear), and $50 for a medical bed rail, the costs add up to approximately $450 of items per patient. Staff training and brochure creation will introduce additional one-time expenses that are not significant, and the price of exercise gear is difficult to determine due to a lack of a training schedule. The bed rails also only have to be bought once per bed.
Outcome and Goals
The goal of this program is to reduce the incidence rate of falls among the residents of the nursing home in question. Responding to falls that have already happened and minimizing the harm to fall victims are beyond the scope of the current proposal. The desired outcome is the achievement of the goal of the program and the resulting decrease in injuries among patients of the institution. Both the target and the result should be attainable through the use of the listed interventions.
The program achieves its goal of preventing falls among the residents of a nursing home through the implementation of a variety of interventions. These include increased vitamin D intake, adjusted medication prescriptions, appropriate footwear, bed rails, communication adjustments, and exercise schedules. The methods require training the staff and purchasing equipment, but the overall costs are manageable. The proposed changes should improve the institution’s ability to prevent falls, but the minimization of harm to patients from falls that occur nevertheless should be addressed in a separate initiative.
Moore, K., Ryan, A., & Rhead, G. (2015). A review of the literature on restraint and the use of bed rails. Web.
Paris, I., Eleftherios, K., Nikolaos, K., Asimenia, G., Thomas, A., & Ioannis, T. (2016). The efficacy of kinesiotherapy in secondary fall prevention among seniors for optimisation of their health quality. International Journal of Health Sciences, 4(4), 41-45.
Pfortmueller, C. A., Lindner, G., & Exadaktylos, A. K. (2014). Reducing fall risk in the elderly: Risk factors and fall prevention, a systematic review. Minerva Medica, 105(4), 275-281.
Quigley, P. (2015). Tailoring falls-prevention interventions to each patient. The American Nurse Today, 10(11), 8-10.
Wolf, L., & Hignett, S. (2015). Are patients at risk for falling? …Not if you ask them. Web.