Prevention of Falls and Injuries Among the Elderly (PDF 2.4M
Abstract Implications of Falls in the Hospital Setting...
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Reducing Falls and Increasing Satisfaction Reducing Falls and Increasing Satisfaction Reducing Falls and Increasing Satisfaction with a Therapeutic Activities Program with a Therapeutic Activities Program with a Therapeutic Activities Program Lise Anne Cooper, RN Lise Anne Cooper, RN Lise Anne Cooper, RN-BC BC BC Abstract Abstract Abstract Introduction: There are many landmark studies regarding the costs to the healthcare system of both de- lirium and patient falls, some of which address specific interventions and programs designed to reduce the incidence of both. With the broad spectrum of causes of both delirium and falls, iatrogenic and other- wise, it is difficult to streamline any one intervention that can protect against all risk factors. Falls pre- vention programs include: special wrist bands, door magnets, “STOP” signs, hourly rounding, “Delirium Risk” medication protocols, call-bell-within-reach protocols, fall risk assessments, patient companions, post-fall huddles, lap belts, chair pad alarms, and bed alarms. Method: In July 2012, the Therapeutic Activities Program was implemented on a large Medical/Surgical unit with a large population of patients at high risk for delirium and falls. The goals of the program were to more easily reorient delirium patients, reduce the incidence of falls, and increase patient satisfaction. Result: The Therapeutic Activities Program has been an added benefit to the unit. Incidence of falls has decreased, patient satisfaction has increased, oriented patients also utilize the activities, and staff and pa- tients feel more engaged with each other through the activities. Conclusion: The Therapeutic Activities Program is another option in the unit’s Falls Prevention Toolbox. Staff engages patients in patient-specific activities designed to stimulate and engage, promote a feeling of empowerment and accomplishment, and help keep the patient relaxed and oriented. Implications of Falls in the Hospital Setting Implications of Falls in the Hospital Setting Implications of Falls in the Hospital Setting Hospital Overview Hospital Overview Hospital Overview Morristown Medical Center (MMC) is certified as a Level I Regional Trauma Center by the American College of Surgeons and Level II by the state of New Jersey. MMC has 658 licensed beds, treating more than 38,300 admissions in 2011. Morristown Medical Center is a teaching hospital that is designated as a Magnet facility for nursing excellence as well as being listed as a Fortune 100 Best Places to Work for the past five years. MMC is the #3 ranked New Jersey hospital by U.S. News & World Report. We are listed on the U.S. News & World Report Best Hospital, ranked nationally in the areas of cardi- ology and heart surgery. We are also listed on the U.S. News & World Report Best Re- gional Hospital, New York Metro area, in the specialties of: cancer, diabetes and endocri- nology, gastroenterology, geriatrics, nephrology, neurology and neurosurgery, orthope- dics, pulmonology, and urology. MMC is listed as a Top Hospital in New Jersey by Cas- tle Connolly Medical and Inside Jersey magazine and is has an “A” rating for Hospital Safety by The Leapfrog Group. MMC holds Beacon Awards for Critical Care Excellence through the American Association of Critical Care Nurses and Safety through the New Jersey State Safety Council. The Morristown Medical Center complex is also the home of Goryeb Children’s Hospital, Carol G. Simon Cancer Center, and Gagnon Cardiovascu- lar Institute. Statistics show that patient falls are the largest single cause of restricted-activity days among older adults and that only 50% of patients who suffer a serious fall will be alive one year later. The death rates related to falls per 100,000 quadruple between the ages of 70 and 80, 30% of people over the age of 65 fall each year, and 70% of accidental deaths in persons over age 75 are caused by falls (Morse, 2002; Fuller, 2000). Falls that re- sult in injury range from 29% to 48%, with the estimated annual cost to exceed $30 billion by the year 2020 (Morse, 2002). Patients are two to three times more likely to die from a traumatic injury than younger patients (Taylor, Tracy, Meyer, Pasquale, & Napolitano, 2002). Lengths of hospital stays are almost double for a pa- tient who falls in the hospital as compared to a patient who does not (Dunn, Rudberg, Furner, & Cassel, 1992). Elderly patients who fall experience a greater functional decline in activities of daily living and are greater risk of readmission (Kiel, O’Sullivan, Teno, & Mor, 1991; Tinetti, Liu, & Claus, 1993). Our Process: PDSA Plan: Develop process for staff, and patients and their families to initiate activities with patients to promote reorientation, safety, and satisfaction. (initiated on July 5, 2012). Do: A Nurse Champion rolled out the Therapeutic Activities Program to the unit by providing staff education in the identification of delirium and the appropriate use of each of the available therapeutic activities. All staff members were empowered with the decision making of when to utilize the therapeutic activities with a patient. Patient companions were trained how and when to engage in interactive therapeutic activities with their as- signed patient. Daily program support was established through unit management. Continuing education was provided at monthly staff meetings. Study: Evaluate the impact of the Therapeutic Activities Program on incidence of falls and patient satisfac- tion, as well as to help delay or diminish the onset of patient delirium. Act: Analysis of fall rates and patient satisfaction data of unit population. FIGURE 1. Factors that contribute to the risk of falls in the elderly population. Falls in the elderly. Am Fam Physician 2000; 61(7), 2159–2168. Conclusions Conclusions Conclusions 1. The availability of therapeutic activities on the unit has been helpful in decreasing patient falls and increasing pa- tient satisfaction. 2. Several other units at Morristown Medical Center have used our Therapeutic Activities Program as a guide and cre- ated their own group of therapeutic activities appropriate for their particular patient population. 3. Continuing supportive and educational efforts in monthly staff meetings will help to keep the Therapeutic Activities Program and the significance of delirium and fall risk factors at the forefront of our patient safety goals program. For quick and easy identification anywhere on the unit, the Therapeutic Activities Program is housed in a multi-colored rolling cart that contains the different activities. The cart is presented to patients and they may choose any activity that interests them. By offering our patients various activities, the unit staff can interact with patients on a more family- oriented level. This cart has also proven to be beneficial to our alert and oriented patients so we have added current books, magazines, DVDs, and a portable DVD player. Examples of Therapeutic Activities Program: The Therapeutic Activities Program has been an immediate hit with our patients. The first patient to utilize the Therapeutic Activities Program, who had spent most of the morning singing at the top of her lungs, much to the dismay of her neighbors, chose a stuffed white canvas dog and promptly colored it with multiple colored spots and named it “Bingo”, she stated “for my granddaughter when she comes by later”. Apparently, the con- centration required for coloring left no available energy for continued singing, so both she and the patients around her were happy. The second patient, a terminally ill young woman, colored in one of the stuffed animals with blessings and nice re- marks that she then gave to her nurse as a thank-you gift for giving her “something to do”. An interesting, alert and oriented, and “bored”, older gentleman chose a small wooden birdhouse to paint because he “used to make birdhouses for my wife”. And yet another patient, whose bed alarm went off every 15 to 30 minutes, was kept pleasantly occupied for over 3 hours while completing a jigsaw puzzle. References: Dunn, J. E., Rudberg, M. A., Furner, S. E., & Cassel, C. K. (1992). Mortality, disability, and falls in older persons: The role of underlying disease and disability. American Journal of Public Health, 82, 395-400. Fuller, G. F. (2000). Falls in the elderly. American Family Physician, 61(7), 2159-2168. Kiel, D. P., O’Sullivan, P., Teno, J. M., & Mor, V. (1991). Health care utilization and functional status in the aged following a fall. Medical Care, 29, 221-228. Morse, J. (2002). Enhancing the safety of hospitalization by reducing patient falls. American Journal of Infection Control, 30(6), 376-380. Taylor, M. D., Tracy, J. K., Meyer, W., Pasquale, M., & Napolitano, L. (2002). Trauma in the elderly: Intensive Care Unit resource use and outcome. Journal of Trauma-Injury Infection & Critical Care, 53(3), 407 -414. Tinetti, M. E., Liu, W. L., 7 Claus, E. B. (1993). Predictors and prognosis of inability to get up after falls among elderly persons. Journal of the American Medical Association, 269, 65-70. 0 2 4 6 8 Jan mar May July Sept Nov Falls Months Unit falls per month 2012
Transcript of Abstract Implications of Falls in the Hospital Setting...
Reducing Falls and Increasing Satisfaction Reducing Falls and Increasing Satisfaction Reducing Falls and Increasing Satisfaction with a Therapeutic Activities Program with a Therapeutic Activities Program with a Therapeutic Activities Program
Lise Anne Cooper, RNLise Anne Cooper, RNLise Anne Cooper, RN---BCBCBC
AbstractAbstractAbstract
Introduction: There are many landmark studies regarding the costs to the healthcare system of both de-
lirium and patient falls, some of which address specific interventions and programs designed to reduce
the incidence of both. With the broad spectrum of causes of both delirium and falls, iatrogenic and other-
wise, it is difficult to streamline any one intervention that can protect against all risk factors. Falls pre-
vention programs include: special wrist bands, door magnets, “STOP” signs, hourly rounding, “Delirium
Risk” medication protocols, call-bell-within-reach protocols, fall risk assessments, patient companions,
post-fall huddles, lap belts, chair pad alarms, and bed alarms.
Method: In July 2012, the Therapeutic Activities Program was implemented on a large Medical/Surgical
unit with a large population of patients at high risk for delirium and falls. The goals of the program were
to more easily reorient delirium patients, reduce the incidence of falls, and increase patient satisfaction.
Result: The Therapeutic Activities Program has been an added benefit to the unit. Incidence of falls has
decreased, patient satisfaction has increased, oriented patients also utilize the activities, and staff and pa-
tients feel more engaged with each other through the activities.
Conclusion: The Therapeutic Activities Program is another option in the unit’s Falls Prevention
Toolbox. Staff engages patients in patient-specific activities designed to stimulate and engage, promote a
feeling of empowerment and accomplishment, and help keep the patient relaxed and oriented.
Implications of Falls in the Hospital SettingImplications of Falls in the Hospital SettingImplications of Falls in the Hospital Setting
Hospital OverviewHospital OverviewHospital Overview Morristown Medical Center (MMC) is certified as a Level I Regional Trauma Center
by the American College of Surgeons and Level II by the state of New Jersey. MMC has
658 licensed beds, treating more than 38,300 admissions in 2011. Morristown Medical
Center is a teaching hospital that is designated as a Magnet facility for nursing excellence
as well as being listed as a Fortune 100 Best Places to Work for the past five years.
MMC is the #3 ranked New Jersey hospital by U.S. News & World Report. We are listed
on the U.S. News & World Report Best Hospital, ranked nationally in the areas of cardi-
ology and heart surgery. We are also listed on the U.S. News & World Report Best Re-
gional Hospital, New York Metro area, in the specialties of: cancer, diabetes and endocri-
nology, gastroenterology, geriatrics, nephrology, neurology and neurosurgery, orthope-
dics, pulmonology, and urology. MMC is listed as a Top Hospital in New Jersey by Cas-
tle Connolly Medical and Inside Jersey magazine and is has an “A” rating for Hospital
Safety by The Leapfrog Group. MMC holds Beacon Awards for Critical Care Excellence
through the American Association of Critical Care Nurses and Safety through the New
Jersey State Safety Council. The Morristown Medical Center complex is also the home
of Goryeb Children’s Hospital, Carol G. Simon Cancer Center, and Gagnon Cardiovascu-
lar Institute.
Statistics show that patient falls are the largest single cause of restricted-activity days among older adults and
that only 50% of patients who suffer a serious fall will be alive one year later. The death rates related to falls
per 100,000 quadruple between the ages of 70 and 80, 30% of people over the age of 65 fall each year, and
70% of accidental deaths in persons over age 75 are caused by falls (Morse, 2002; Fuller, 2000). Falls that re-
sult in injury range from 29% to 48%, with the estimated annual cost to exceed $30 billion by the year 2020
(Morse, 2002). Patients are two to three times more likely to die from a traumatic injury than younger patients
(Taylor, Tracy, Meyer, Pasquale, & Napolitano, 2002). Lengths of hospital stays are almost double for a pa-
tient who falls in the hospital as compared to a patient who does not (Dunn, Rudberg, Furner, & Cassel, 1992).
Elderly patients who fall experience a greater functional decline in activities of daily living and are greater risk
of readmission (Kiel, O’Sullivan, Teno, & Mor, 1991; Tinetti, Liu, & Claus, 1993).
Our Process: PDSA
Plan: Develop process for staff, and patients and their families to initiate activities with patients to promote
reorientation, safety, and satisfaction. (initiated on July 5, 2012).
Do: A Nurse Champion rolled out the Therapeutic Activities Program to the unit by providing staff education
in the identification of delirium and the appropriate use of each of the available therapeutic activities. All staff
members were empowered with the decision making of when to utilize the therapeutic activities with a patient.
Patient companions were trained how and when to engage in interactive therapeutic activities with their as-
signed patient. Daily program support was established through unit management. Continuing education was
provided at monthly staff meetings.
Study: Evaluate the impact of the Therapeutic Activities Program on incidence of falls and patient satisfac-
tion, as well as to help delay or diminish the onset of patient delirium.
Act: Analysis of fall rates and patient satisfaction data of unit population.
FIGURE 1.
Factors that contribute to the risk of falls in the elderly population.
Falls in the elderly. Am Fam Physician 2000; 61(7), 2159–2168.
ConclusionsConclusionsConclusions 1. The availability of therapeutic activities on the unit has been helpful in decreasing patient falls and increasing pa-
tient satisfaction.
2. Several other units at Morristown Medical Center have used our Therapeutic Activities Program as a guide and cre-
ated their own group of therapeutic activities appropriate for their particular patient population.
3. Continuing supportive and educational efforts in monthly staff meetings will help to keep the Therapeutic Activities
Program and the significance of delirium and fall risk factors at the forefront of our patient safety goals program.
For quick and easy identification anywhere on the unit, the Therapeutic Activities Program is housed in a multi-colored
rolling cart that contains the different activities. The cart is presented to patients and they may choose any activity that
interests them. By offering our patients various activities, the unit staff can interact with patients on a more family-
oriented level. This cart has also proven to be beneficial to our alert and oriented patients so we have added current
books, magazines, DVDs, and a portable DVD player.
Examples of Therapeutic Activities Program:
The Therapeutic Activities Program has been an immediate hit with our patients.
The first patient to utilize the Therapeutic Activities Program, who had spent most of the morning singing at the top of
her lungs, much to the dismay of her neighbors, chose a stuffed white canvas dog and promptly colored it with multiple
colored spots and named it “Bingo”, she stated “for my granddaughter when she comes by later”. Apparently, the con-
centration required for coloring left no available energy for continued singing, so both she and the patients around her
were happy.
The second patient, a terminally ill young woman, colored in one of the stuffed animals with blessings and nice re-
marks that she then gave to her nurse as a thank-you gift for giving her “something to do”.
An interesting, alert and oriented, and “bored”, older gentleman chose a small wooden birdhouse to paint because he
“used to make birdhouses for my wife”.
And yet another patient, whose bed alarm went off every 15 to 30 minutes, was kept pleasantly occupied for over 3
hours while completing a jigsaw puzzle.
References:
Dunn, J. E., Rudberg, M. A., Furner, S. E., & Cassel, C. K. (1992). Mortality, disability, and falls in older persons: The role of underlying disease and disability. American Journal of Public Health, 82, 395-400.
Fuller, G. F. (2000). Falls in the elderly. American Family Physician, 61(7), 2159-2168.
Kiel, D. P., O’Sullivan, P., Teno, J. M., & Mor, V. (1991). Health care utilization and functional status in the aged following a fall. Medical Care, 29, 221-228.
Morse, J. (2002). Enhancing the safety of hospitalization by reducing patient
falls. American Journal of Infection Control, 30(6), 376-380.
Taylor, M. D., Tracy, J. K., Meyer, W., Pasquale, M., & Napolitano, L. (2002). Trauma in the elderly: Intensive Care Unit resource use and outcome. Journal of Trauma-Injury Infection & Critical Care, 53(3), 407
-414.
Tinetti, M. E., Liu, W. L., 7 Claus, E. B. (1993). Predictors and prognosis of inability to get up after falls among elderly persons. Journal of the American Medical Association, 269, 65-70.
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