Falls and Fall Prevention _ _____________________________________________________________________
In addition, the CDC STEADI initiative includes a fall pre- vention toolkit specifically designed for inpatient use. This was developed to help inpatient organizations integrate fall prevention programs into their current practices. The STEADI initiative includes 10 practical steps identified by research findings and provider practices to [22]: • Reduce patient falls during and after hospital stays • Foster better partnership with outside providers for post-hospital discharge care • Upgrade hospital practices and records • Recognize and appropriately manage medications that place patients at an increased fall risk The STEADI initiative also outlines suggested tasks for all members of the interprofessional team in support of safe mobility and fall prevention ( Table 1 ).
The NCOA has initiatives for fall prevention programs that are geared toward the home settings. This Falls Free Initiative is led by the National Falls Prevention Resource Center. The Falls Free Initiative works with more than 70 organizations nationwide to develop strategies to prevent falls, fall-related injuries, and fall-related deaths. The Falls Free Initiative can be accessed online at https://www.ncoa.org/article/get-the- facts-on-falls-prevention [23]. PEDIATRIC FALL PREVENTION The Humpty Dumpty Falls Scale (HDFS) serves as an interna- tional tool to help assess pediatric fall risk. Developed in Brazil, this tool is used within the inpatient setting with patients birth to 21 years of age. The parameters include age, gender, diagno- sis, impairments, environmental factors, response to surgery/ anesthesia (if applicable), and medication usage responses are scored on a 1–4 scale. Scores less than 12 indicate low risk, while scores of 12 or greater are considered at high risk for falls. The HDFS is used at admission, daily, and with any changes in level of care [27].
SUGGESTED TASKS FOR SAFE MOBILITY AND FALL PREVENTION PROGRAM TEAM MEMBERS
Team Member
Suggested Tasks
STEADI safe mobility champion (from any profession)
• Proactively encourage early mobilization of patients to reduce fall risks during hospitalization • Work with team to incorporate the safe mobility and fall prevention program into the patient care workflow • Work with available unit-based or hospital educators to establish a training program for current and future employees • Be available to troubleshoot issues during implementation • Provide feedback to team members • Monitor and report results of program implementation • Communicate with hospital leadership about the program • Assign and train staff to discuss fall prevention strategies with patients and caregivers • Screen patients for fall risk using a screening tool (e.g., Stay Independent checklist, three key questions, STRATIFY Risk Assessment Tool) • Perform gait testing (e.g., Timed Up and Go Test, 30-Second Chair Stand Test, or 4-Stage Balance Test) • Check orthostatic blood pressure • Educate patients about orthostatic hypotension and related fall risk • Discuss fall prevention strategies with patients and caregivers • Perform vision assessment (e.g., Snellen eye chart) • Counsel about using single distance lenses when walking outside (e.g. avoid bifocals) • Assess feet and footwear • Conduct cognitive assessment (e.g., Mini-Cog) • Ensure each patient has optimal independence in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) during hospital stay • Mobilize patient at least three times a day as tolerated • Give patient appropriate STEADI patient educational materials • Follow up during their hospital stay to ensure patients are making progress as part of fall prevention care plan Table 1 continues on next page.
Nurse and/or certified nursing assistant
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