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QIO HHQI Weekly Update :: April 2, 2007  

TIP OF THE WEEK

Ten core elements of the fall risk assessment for staff training

  1. Age 65+
    • 1 in 3 adults over the age of 65 falls each year.
    • In 1999, 10,000 people age 65 and older died from fall-related injuries.
    • In 2000, 1.6 million adults 65 and over were treated in emergency rooms for fall-related injuries and 353,000 were hospitalized.
    • 3% to 5% of these falls result in fractures.
    • Based on the 2000 census, this translates to 360,000 to 480,000 fall-related fractures each year. (CDC 2001).

  2. Diagnosis (3 or more co-existing)
    • Community-dwelling elders average 3 to 4 coexistent diseases.
    • Assess for hypotension.

  3. Prior history of falls within 3 months
    • Fall Definition: “An unintentional change in position resulting in coming to rest on the ground or at a lower level.”
    • Define a fall using the definition above.
    • Fall frequency and level of disability are statistically correlated.
    • Falls should not be accepted as a normal part of aging, but possibly due to inactivity or poor nutrition or a marker of an underlying disease or the development of one.

  4. Incontinence
    • Inability to make it to the bathroom or commode in timely manner.
    • Possibility of slipping in urine on the floor.
    • Frequency, urgency, and/or nocturia.

  5. Visual impairment
    • Macular degeneration.
    • Diabetic retinopathies.
    • Visual field loss due to stroke.
    • Age-related changes, decline in visual acuity, accommodation, glare tolerance, depth perception, and night vision.
    • Not wearing prescribed glasses or having the correct prescription.

  6. Impaired functional mobility
    • Could include patients who need help with IADLS or ADLS
    • Gait or transfer problems
    • Often functional status is affected by:
      • Musculoskeletal factors such as gait/balance disorders, osteoarthritis, rheumatoid arthritis, osteoporosis, muscle imbalance and atrophy, fractures, soft tissue injury and pain
      • Neurological factors that cause impairments in proprioception, nerve conduction velocity or protective reflexes as found in Parkinson’s, MS, stroke, vestibular conditions, and diabetes.
      • Fear of falling concern restricts or creates tensing results in mobility impairment.
      • Foot problems
      • Improper use of assistive devices
      • Impaired sensation
      • Impaired coordination

  7. Environmental hazards
    • Poor illumination.
    • Poor color contrast between surfaces.
    • Floor surfaces that are uneven or cluttered, throw rugs, unsuitable pathways, furnishings that are unstable or too low.
    • Hard to reach items.
    • Stairways that may need railings added or secured.
    • Bathroom adaptive equipment needs.
    • Outdoor entry and exits.
    • Equipment tubing.
    • Inappropriate footwear.
    • Pets.

  8. Poly Pharmacy (4 or more prescriptions)
    • Drugs highly associated with fall risk include:
      • Sedatives and anxiolytics
      • Tricyclic antidepressants
      • Tranquilizers
      • Narcotics
      • Anti-hypertensive, cardiac meds
      • Corticosteroids
      • Anti-anxiety drugs
      • Anticholinergic drugs
      • Hypoglycemic agents
    • Research shows any four or more prescription medications of any category are associated with fall risk.
    • Additional attention should be paid to dosages due to physiological changes related to aging.

  9. Pain affecting level of function
    • Pain often affects an individual’s desire or ability to move.
    • Pain can also be a factor in depression or compliance with safety recommendations.

  10. Cognitive impairment
    • Could include patients with dementia, Alzheimer’s, or stroke patients.
    • Patients who are confused, use poor judgment, or are depressed.
    • Any condition that results in slowed processing, poor judgment, decreased comprehension, impulsivity, or memory deficits.
    • Consider patients ability to adhere to the plan of care.

Excerpted from Staff Training Tool for Fall Risk Assessment, Missouri Alliance for Home Care.


 

RESOURCE SPOTLIGHT

Mobility in Action Cards (PDF)
Home health agencies can use these cards to educate staff, patients, and caregivers interventions to improve mobility. The cards are separated into five categories. Each set has a different focus:

  • Gold: highlights posture tips
  • Purple: designates mobility in action
  • Green: focuses on making exercise a regular part the day
  • Orange: offers facts, called "Did you know?" that support a healthy lifestyle
  • Blue: reminds providers, patients, and family members to encourage patient independence by not being too quick to help

 

IN THE NEWS

HOW SEAMLESS CARE TRANSITIONS FOR THE FRAIL ELDERLY CAN REDUCE UTILIZATION AND HOSPITALIZATIONS AND ENHANCE QUALITY OF LIFE

March 22, 2007 -- PR Newswire -- Managing Transitions to Care for the Frail Elderly, an April 26, 2007 audio conference, will explore how to create effective care management approaches for the frail elderly. Read more >>

 

PROBLEMS WITH PATIENT COMMUNICATION INCREASE RISK FOR INJURY, DEATH

March 26, 2007 -- Kaiser Network -- Problems with communication between patients and health care providers can increase risk for injury or death for those who require medical care, according to a report recently released by the Joint Commission, USA Today reports. The report found that cultural and language barriers, as well as low literacy skills among patients, can affect communication between patients and providers. Read more >>

 

NURSING HOMES SEEKING MORE SHORT-TERM, LUCRATIVE REHAB PATIENTS

March 27, 2007 -- Kaiser Network -- The AP/Atlanta Journal-Constitution examined how, with "billions of dollars at stake, nursing homes across the nation are rushing to reinvent themselves to compete with hospitals and affiliated rehabilitation facilities for short-term, higher-paying patients." The nursing home industry for decades has focused on older, sicker patients. Read more >>

 

NURSING HOMES WANT STATE TO PAY WORKERS' COMP HIKE

March 28, 2007 -- Zanesville Times Recorder -- A trade group representing Ohio nursing homes is asking the Ohio Supreme Court to decide who should pay for increases in premiums to the state's injured-worker insurance program.

 

Lower courts have ruled in the state's favor, ordering nursing homes to pay the additional amount. The nursing homes are asking that the state cover payments for increases that occurred when the Ohio Bureau of Workers' Compensation ended a discount for businesses. Read more >>

 

COMING ATTRACTIONS

ARE YOU READY FOR PAY FOR PERFORMANCE?

Attend one of these half-day meetings to learn more about:

  • Current pay-for-performance demonstration projects.
  • How Ohio agencies are performing on key measures.
  • Best practices and barriers of Ohio agencies.
  • Using tele-triage as a quality improvement strategy.

Choose the AM (9-12) or PM (1-4) session. Registration begins 30 minutes prior to the start of the conference. Register today for a meeting in your area:

  • 4/4/07: Cleveland

Who should attend? CEO, Administrator, Operations, Director of Clinical Services, Nurses, or Quality Improvement Coordinator.

Click here for more information or to register now


The Tip of the Week Archive is available on the Ohio KePRO Web Site.