_____________________________________________________________________ Falls and Fall Prevention
Physician, nurse practitioner, physician assistant, clinical nurse specialist
• Take a fall history, including circumstances of previous falls • During physical exam include an observation of gait to identify medical issues that could increase fall risk (e.g., cardiac or neurologic disease) • Review results of fall risk assessments performed by other team members • Avoid prescribing and manage medications that increase fall risk (collaborate with pharmacists) • Order appropriate labs and imaging specific to fall risk • Recommend and provide referrals specific to fall risk • Discuss fall prevention strategies with patients and caregivers • Engage patients and caregivers in developing and implementing individual fall prevention care plans • Avoid issuing bed rest orders or discontinue them as soon as not clinically indicated • Discontinue tethers (IV lines, urinary catheters, etc.) as soon as not clinically indicated • Recommend community exercise or fall prevention programs • Review medications to identify those that increase fall risk • Notify safe mobility and fall prevention program team of any medications that might increase fall risk and set up alerts to providers for those medications • Make recommendations for dose reduction or safer alternatives for medications that increase fall risk • Raise awareness about medication-related fall risks • Discuss fall prevention strategies with patients and caregivers • Assess or inquire about baseline functional status • Discuss fall prevention strategies with patients and caregivers • Perform detailed gait and balance testing • Design a rehabilitation care plan or exercise program to improve mobility and balance during hospitalization • Educate patients about community-based fall prevention programs, such as tai chi classes or Stepping On
Pharmacist
Physical therapist
Occupational therapist4 • Discuss fall prevention strategies with patients and caregivers • Educate patients about home trip hazards (e.g. throw rugs, stairs)
• Recommend fall prevention safety features (e.g., grab bars, lighting, railings) • Educate patients and caregivers about behavioral and functional changes that impact fall risk
Source: [22]
Table 1
rhyme for the aging, a cautionary tale on the importance of staying active and the hidden danger in simply sitting still. Humpty Dumpty can connote age, inactivity, weight gain, solitude, and fragility. Sedentary life has the appearance of safety but the place where one sits is not always safe, and the consequences of falling can be dire. Falls are common in older adults, and the risk of falling increases with aging. While this course has focused on the older adult population, persons of all ages can be at risk for falls for a variety of reasons. Preventive measures can be used for any adult and all patients with limited mobility. Strategies for effective prevention of falls begin with proper assessment of predisposing factors and comorbidities, focusing on managing extrinsic and intrinsic factors that increase risk. Timely educa- tion of patients and families is recommended in the primary and secondary prevention of falls. By striving for the goal of zero falls, healthcare facilities and providers can achieve a significant reduction in number of injuries and loss of life. A given patient’s fall risk can be reduced significantly in a single healthcare contact, using a prepared strategy (e.g., STEADI
CONCLUSION Falling is among life’s earliest and most common experiences. Is there anyone who has not fallen while learning to walk, or not stumbled when in too much of a hurry? When we are young, like “Jack and Jill (who) went up the hill to fetch a pail of water,” falling can be painful but is often of little consequence to life and limb; moreover, falling down teaches resilience and the importance of being careful. Jack and Jill likely jumped up no worse for the wear and later went right back up the hill again. It is worth noting here that these two were out and about, active at play or doing chores. The tale of Jack and Jill connotes youth, energy, exuberance, companionship; their danger of falling came from being too much in a hurry. Humpty Dumpty, on the other hand, tells a more somber tale. He was not out and about at all, just simply sitting on the wall; and when he fell it was a “great fall” (of serious consequence). All the king’s horses and all the king’s men couldn’t put Humpty together again! Perhaps Humpty Dumpty is a nursery
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MDPA2126
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