Fall Prevention : Fall Prevention Jewish Hospital 3 East Current Policy : Current Policy Pathophysiology : Pathophysiology Osteoarthritis
A disease characterized by loss of articular cartilage in articulating joints and hypertrophy of the bones at the articular margins
Etiology: can be idiopathic or secondary to known risk factors Risk Factors : Risk Factors Increased age
Inflammation of joint structures
Joint instability Endocrine disorders
Hormonal factors Manifestations : Manifestations Slow and gradual onset
Pain or stiffness in one or more joints –usually 1st symptom
Limited ROM of joints
Enlarged joints Relating osteoarthritis to 3 East : Relating osteoarthritis to 3 East Osteoarthritis is one of the major risk factors for falls
56% of patients on 3 East on October 6, 2009 had an admitting diagnosis of osteoarthritis Evidence-Based Practice : Evidence-Based Practice 79.5% (Tzeng 2009) Evidence-Based Practice : Evidence-Based Practice 57% of patients surveyed felt fall prevention programs were not adequate enough to prevent falls (J) Floor Findings : Floor Findings Statistics : Statistics More than 1/3 of all adults over 65 fall each year (Burke 2009).
Fall incidents are the 3rd cause of chronic disablement in older persons (Arnold 2009).
10-15% of falls among the elderly result in loss of independence, fractures, hospital admission, or death (Shandro 2007).
Hip fractures are the most common injury in the older population. It results in the greatest number of deaths and the most serious health problems of all fractures for people 65 or older (Burke 2009). Assessment : Assessment Health history
Functional Mobility Assessment
Fall Risk scale
Assess home setting
Medication Nursing Diagnosis : Nursing Diagnosis Risk for Falls
Risk for Injury
Knowledge Deficit Preventative Measures : Preventative Measures The Joint Commissions reasons for fatal falls
Inadequate staff communication and incomplete staff orientation and training
Incomplete patient assessments and reassessments
Incomplete care planning and unavailable or delayed care provision
Inadequate organizational culture of safety
(Tzeng 2008) Preventative Measures : Preventative Measures Lighting of floor surfaces and hallways
Bed in low and locked position and side rails up x2
Bed alarm systems activated
(Lyons 2005) Comprehensive falls evaluation, treatment of underlying health conditions
exercise programs, balance and gait training
toileting programs Teaching : Teaching Teach patient how to ambulate safely at home
Teach importance of maintaining regular exercise program at home
Teach patient how to properly use assistive devices such as a cane or walker
Teach patient how to properly identify fall hazards
(Burke 2009), (Ackley 2008) References : References Ackley, B.J., & Ladwig, G.B. (2008). Nursing diagnosis handbook: an evidence-based guide to planning care. St. Louis, Missouri: Mosby Inc.
Arnold, C.M,& Faulkner, R.A. (2009). “Does Fall-efficacy predict balance performance in older adults with hip osteoarthritis.” Journal of Gerontological Nursing, 35(1),45-52.
Burke, K & LeMone, P. (2009). Medical- Surgical Nursing. New Jersey. Pearson Education Inc.
Lyons, S. (2005)“Fall Prevention for Older Adults.” Journal of Gerontological Nursing, 9-14.
Shandro, J.R., Spain, D.A., Dicker, R.A.(2007) “Recruitment Strategies for a Fall Prevention Program: If We Build It, Will They Really Come.” The Journal of TRAUMA Injury, Infection and Critical Care,142-146
Tzeng HM, Yin CY. Extrinsic Risk Factors for Inpatient Falls in Hospital Rooms. J Nurs Qual. 2008; 23(3): 233-241
Tzeng HM, Yin CY.(2009) “Perspectives of Recently Discharged Patients on Hosptial Fall- Prevention Programs.” J Nurs Care Qual, 42-49.