It requires a combination of medical treatment, rehabilitation, and environmental changes. By having a deeper understanding of the factors predisposing Harold to falls, the following care interventions were made to prevent Harold from falling again: • Conduct comprehensive oral assessment and treat his oral impairment. Rather than seeking the answer as to why Ruth was moving away from the back of her wheelchair and therefore pushing her right hip into extension, the interdisciplinary team focused on how to keep her in her chair and prevent her from falling. To increase the likelihood that individuals will remain seated, they must be comfortable and engaged in life around them. Some of these advances are attributable to the development of new materials, such as polyurethane foam, which can absorb up to 90% of the impact of a fall.34 Although such materials are thinner and feel soft, they become firmer on impact, enabling the pressure to be distributed across a greater area. 1994;121(6):442-451. When the interdisciplinary team discovers that a resident fell after sliding into a sacral sitting position or attempting to transfer from a wheelchair while unsupervised, they often look for a urinary tract infection, attribute it to a need to use the toilet, or blame the resident for having a behavioral problem that causes him or her not to wait for staff assistance. Bakker R. Environmental design. Despite best efforts on this front, some falls will continue to occur. URMC Today. Cur-rently, no tool exists to guide nurses and other healthcare team members in assessing risk for in - jury from unanticipated falls… Not only can ill-fitting or worn-out shoes contribute to falls, but they can also increase the likelihood of developing painful bunions, corns, and blisters.28 The exception to this would be individuals with a festinating gait pattern, such as ambulatory residents with Parkinson’s disease. Vitamin D and calcium recommendations: making sense of the hype and the reality. • Allowing the resident to sit for a period while the gait belt is applied before he or she rises to a standing position. Staff members resorted first to using a lap buddy, a cushion that is placed into the wheelchair and across the lap of the individual to prevent him or her from trying to stand unassisted while providing upper body support and posture assistance. Any modification to how these drugs are used should be communicated to the nursing assistants, who are charged with assisting residents to rise safely from the supine or sitting positions. 2011;59(1):148-157. www.americangeriatrics.org/files/documents/health_care_pros/JAGS.Falls.Guidelines.pdf. SUGGESTED RESIDENT INTERVENTIONS TO MANAGE FALLS FALL FROM BED Resident Able to Transfer Make sure bed is locked and in lowest position Provide a night light Clear path to the bathroom—no obstacles Call light within reach and secured Toilet schedule Footwear to prevent slipping (ex. Effective fall prevention strategies without physical restraints or personal alarms [transcript]. with fall precaution interventions, is impulsive or lacks safety awareness, has a history of a physiologic fall within the last 6 months or at the discretion of the nurse. Once a comprehensive fall risk assessment is completed, the team must plan care interventions to reverse or address each risk identified on the falls assessment instrument. Fall prevention is a challenge in any healthcare facility, but none more so than the acute psychiatric hospital setting. Accessed December 30, 2013. As these cases show, post-fall huddles with an honest discussion of the circumstances surrounding the fall with the entire interdisciplinary care team and even the resident’s family members is critical, as each of these individuals may have important information that may help shed light on the actual cause(s) behind the fall.
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