Policies Of Falls Prevention In Residential Aged Care Settings In The NSW Government And SA Health Standard 10

The Urgency for Falls Prevention in Elderly Care

Discuss about the Ageing Health and Human Services.

In this assignment I would like to investigate policies Of Falls Prevention in Residential Aged Care Settings of the NSW government (Cec.health.nsw.gov.au 2018). I would also like to contrast it with the policies outlined in Standard 10 of preventing falls and harm from falls (Falls prevention :: SA Health 2018)

Injuries related to falls are more common among elderly people and is one of the major contributors of pain, disabilities, loss of independency as well as death. Every year, approximately 28% to 35% elderly people above 65 years of age experiences falls, the risk of falls further increases to 32%to 42% for individuals 70 years or older. Furthermore, the health system cost per injury due to fall for individuals 65 years or older in Australia is about AU$ 6500, as of 2001-2002 (Falls Prevention in Older Age 2018). In South Australia, 22,576 people were hospitalised after a fall, 65% of whom were individuals 65 years or above, and caused 400 deaths among older people (sahealth.sa.gov.au 2018).

Standard 10, Preventing Falls and Harm from Falls, Safety and Quality Improvement guide (2012) outlined criteria to prevent falls and harm from falls such as: governance systems, screening and assessment, preventative strategies and communication, which focuses on improvement on safety as well as quality of care for elderly residents (safetyandquality.gov.au, 2018).

I would like to recommend the strategic outline as proposed in the Standard 10 of Preventing Falls and Harm from fall, which includes strategies for governance, screening and assessment, fall prevention and communication. The outline is given below:

• Ensuring policies, protocols and procedures which are consistent with the best practice guidelines are used (wherever possible) and utilise screening and assessment tools.
• Regular monitoring of the use of procedures, policies and protocols to prevent and reduce risk of falls
• Ensuring regular reporting, investigating and monitoring incidents of falls is utilised
• The frequency and severity of falls in the healthcare facility are monitored and investigated using administrative and clinical data
• Data on falls are reported to the top levels of governance in the organization
• Taking actions to reduce the frequency as well as severity of falls in the care setup
• Preventing falls and reducing harm to resident through quality improvement
• Ensuring that devices and equipments are available to implement preventative strategies and management plans to prevent and reduce the harm from falling
• Using screening tools from best practice to identify the risk of falling among older residents
• Monitoring the use of screening tools in order to identify the proportion of residents at risk who were screened for falls
• Taking proper action to improve the number of residents being screened for fall risks during admission as well as upon presentation of an incident of fall
• Using best practice assessment tool for the assessment of residents at risk of falling
• Monitoring the use of assessment tools to identify the proportion of residents who completed fall assessment
• Ensuring participation of patients and caregivers while developing or amending prevention plans.
• Taking proper actions to improve the number of residents undergoing complete assessment of fall risk
• Using best practice for minimisation of harm and multifactorial prevention of falls, and recording them in the clinical records of the patient
• Regular monitoring of falls prevention and harm reduction strategies for their efficiency, appropriateness and effectiveness.
• Taking action to reduce the risk of falls and reduce harm for residents at risk of falling
• Referrals to appropriate service provided upon discharge (wherever possible)
• Information on falls and their prevention strategies are given to the patients as well as their caregivers in a simple, meaningful and understandable format.
• Developing fall prevention plan in partnership with the patients and caregivers(safetyandquality.gov.au, 2018).

Stakeholders are individuals who are involved or have interest in the aged care system and include beneficiaries, providers and funders (DefinedTerm: Stakeholders, 2018)

The stakeholders who needs to be engaged in the policies for the prevention and reduction of injuries due to falls among elderly residents and patients includes: Facility administration, Care Manager/Director of Nursing, clinical educator, quality assurance personnel, registered nurses, Care workers, general practitioners, patients and their families, and government authorities (caresearch.com.au, 2018; Poulton et al. 2017)

The facility administration’s involvement would include vital strategies like planning and implementation of preventative strategies, and addressing concerns identified by risk assessment. They have the overall responsibility of the wellbeing of the residents, ensuring safety in the care facility, and also monitoring and investigating reports of falls. The administration can also facilitate the implementation of change processes, outline standards of best practice, and ensure compliance to preventative practices (Myers et al. 2016).

The care manager can be involved in a more personalized approach of fall prevention and minimization of harm from falls. They can be involved in the care planning of the patients, ensuring adequate screening for risks and monitoring of screening efficiency.  The care manager can also overlook the treatment given to the patients. Care managers are often form the front lines of leadership and are responsible for the day to day operations including managing and recruiting staff, managing budgets and ensuring the quality of care meets the national standards of care (Huber, 2017).

Comparison of Falls Prevention Policies in NSW Government and SA Health Standard 10

Clinical educators or nursing professional development specialists can be involved in the training of nurses and healthcare professionals. They can ensure that the nurses have the necessary skills and training to conduct their responsibilities efficiently and effectively. This also requires coordination with the facility administration to identify training needs as per the care goals of the organization. The educators can formulate plans and implement training on strategies to prevent and reduce the risks of falling among the elderly residents (Myer et al., 2017).

Quality assurance team can be involved to ensure maintenance of standard quality of care and constantly review the efficacy of the care provided by the organization. They can also monitor the usage of screening tools and preventative strategies, ensuring their optimum usage at maximum efficiency (Puri et al. 2018).

Registered nurse can be involved in the provision of specialized care for the elderly residents, which can reduce the risks of falling. They have specialization in geriatric care, and are able to assess both physical and mental ailments of the patents. They also can be involved in providing basic care as well as monitor the patient conditions, assess their health, reporting to physicians and also providing medications whenever needed.

Care workers are important support groups that bridge the gap between the healthcare professionals and the patient and their families. They can ensure continuation of care given to the patients. They can be involved in patient’s follow-up and ensure safety and wellbeing of the patients after discharge.

General physician’s involvement is also vital since they have the necessary expertise in the treatment of the patients, as well as ensuring proper assessment of the risks of falling.

Government Authorities’ involvement can also be recommended since the incidents of fall are closely associated with significant rates of disability and death among elderly patients, and therefore is a public health concern apart from the cost burden on the healthcare industry (in the form of insurance coverage).

The process of developing, implementing and reviewing procedures and protocols related to fall prevention and reduction of risks from falls can be implemented an aged care setting under various scenarios. In an aged care centre, residents often suffer from long term or chronic disabilities which increase their risks of falling like cognitive deficit, lack of balance or mobility, vision impairments, physical disabilities (Bunn et al., 2014). Additionally, environmental risks and medications can also increase the risk. Some of the scenarios are discussed below:

Patients with poor balance or mobility are unable to maintain their balance very well, and have difficulties in movement. This increases their risk of falling due to a reduced musculoskeletal and motor coordination. Patients can be regularly assessed for such aspects to identify individuals with reduced ability to move and balance themselves (Caetano et al., 2018; Merryweather et al., 2015). Such patients can be given support to reduce their risks of falling as an effective preventative measure.

Patients with cognitive impairments due to neurodegenerative conditions like dementia, alzhimers or Parkinson have a reduced ability to remember things, and also affect their motor coordination skills. Such patients also show postural instability as well as an inability to understand environmental hazards of falling (Amar et al., 2015). Assessment of environmental risks as well as their cognitive performance can be important to minimise the risks of falling. Additionally, assessment of their postural stability can be done to understand patients at risk (Jabelli et al., 2016). Using memory aids like notes, alarms and visual cues can also be considered to aid their cognition, and help them to remember things (Migo et al., 2015).

Recommendation for Strategic Outline as Proposed in SA Health Standard 10

Patients with incontinence as one of the geriatric symptoms are at risks of falling due to the effect of their impairment on multiple organ systems. The associations of the impairments are mostly related to visual and audio impairments as well as anxiety, depression and lower limb impairment (Pahwa et al., 2016). This also increases their risks of falling further, due to which it is important to assess their health condition as well as the risks of falling.

Issues with feet and footwear can increase the risks of falling among older people. Health issues like diabetic foot ulcers can be caused due to the degeneration of neurons of the lower extremities like feet due to diabetes, which reduced the sensations of the foot, increasing the risks of falling, and injury to the foot. Patients with diabetes therefore should be checked for foot ulceration and the quality of footwear they use for identifying any risks of falling (Al-Rubeaan et al., 2015).

Patients who are at the risks of syncope /fainting are also at high risks of falling. The risks are because of a reduced blood flow to the brain which results in blackouts. Sudden fainting therefore can highly increase the risks of falling among the patients (de Vries et al., 2018). It is therefore important to analyse patients at risks of syncope, and recommend treatment to prevent accidental blackouts.

Patients with Dizziness and vertigo also can face problems with balance and maintenance of posture. This can increase their risks of falling and accidental injury (Matarese et al., 2015). Treatment of the symptoms of dizziness and vertigo therefore is very crucial for the prevention and reduction of harm from falling among such patients.

Medication issues can also lead to musculo-motor impairments and lead to symptoms like dizziness, vertigo and reductions in motor shills which can increase their risks of falling (de Vries et al., 2018). Patients with physical disabilities like visual impairments can also have higher risks of falling due to the inability to identify environmental risks of falling, and tripping hazards.

The first strategy for high risk individuals is a thorough assessment of the risks of falling among the individuals through understanding their physical conditions and ailments and how they affect their risks of falling. A significant strategy for the prevention of the risk of falling includes understanding of any environmental risks that can increase tripping and falling hazards in the aged care centre and then eliminating them. Another strategy is for the improvement of the motor coordination and musculoskeletal skills among the patients (Goodwin et al., 2014).

The sense of balance as well as musculoskeletal and motor coordination can be improved through various physical exercise routines that are aimed to improve the sense of balance among the elderly residents. For example, specialised aerobics programs, tai-chi training, yoga therapy, gardening, outdoor walks, and games can be utilised in the care setup for the various residents to help them gain their sense of balance and thereby reducing the risks of falling (Canning et al., 2015; Schoene et al., 2017; Wayne et al., 2015). Studies have shown that routines like yoga therapy, tai-chi and physical exercise can help to improve the motor coordination of the residents, and reduce their risks of falling (Altenburger et al., 2016; Saravanakumar et al., 2014). Routines like yoga therapy and tai-chi also can help the residents to improve the posture of the patients, as well as help them to practice breathing Saravanakumar et al., 2014).

Stakeholder Engagement for Preventative Strategies

The advantage of using interventions like exercise, tai-chi and yoga is that it can help the patients to develop their motor skills and reduce their risks of falling and it can also have a therapeutic effect on the mental and emotional well being of the patients (Canning et al., 2015; Schoene et al., 2017; Wayne et al., 2015). However a major disadvantage is that such interventions cannot be utilised equally for every residents. Being involved in physical activities can be challenging for many patients with physical disabilities or advanced stages of musculoskeletal, neuromuscular, cognitive and motor skill deficits, due to which they might experience challenges in following the instructions of the trainers (Benjamin et al., 2014). In such scenarios, it is important to tailor the interventions based on the specific condition each resident is suffering from, and utilising strategies best fit for such scenarios. It can be helpful to categorise the patients based on the levels and types of physical activity that the patients can be engaged in, keeping into consideration any physical symptoms and disabilities of the patients.

Activities like gardening or taking a stroll can also help residents with limited mobility to improve their sense of balance and also instil in them confidence of moving independently (Nelson et al., 2017). This is a significant strategy for patients who cannot be involved in other physical exercises, but have the potential to take part in them after some recovery.

In the aged care centre, long term program can be included which incorporates the strategies above, encouraging voluntary participation of residents as well as through referrals from nurses, general physicians and care workers in the intervention and rehabilitation programs to regain their balance. The patients can be systematically trained to be able to take care of themselves through self care strategies, and also foster independence among them. AT the same time, regular monitoring of the preventative strategies can help the providers to assess the utilization of the intervention, their effectiveness in reducing the risks of falling and also help the healthcare professionals to identify potential areas of development of consideration that should be addressed (Bentley et al., 2015).

Gschwind et al. (2013) discussed the best practices for fall prevention exercise programs that can be used to impro0ve balance, strength, power and psychosocial health among the elderly residents. The study focuses on managing the effects of sarcopenia or neuromuscular deficit, which increases the risks of falling. The recommended preventative strategy can follow the key testing and assessment protocols like static and dynamic steady state balance (using Sharpened Romberg Test and instrumented gait analysis), proactive balance assessment (using Functional Reach Test and Timed Up and Go Test), reactive balance assessment ( using perturbation test during bipedal stance and Push and Release Test), strength assessment ( using hand grip strength test and Chair Stand Test) (Gras et al., 2017; Schülein et al., 2017)). Also, the body composition of the residents can be analyzed by bioelectrical impedance analysis systems. This can help to identify patients with frail and poor body mass composition which can adversely affect their ability to be involved in physical activities. Quationnai9res can also be used in order to assess the psychosocial state of the patients. Questionnaires such as World Health Organisation Quality of Life Assessment-Brief can be utilized for the psychosocial assessment. Cognitive performance can be examined through mini mental scale exam, which can help to identify symptoms of cognitive deficits of the patients (Kaur et al., 2016; Paul et al., 2014). Fall efficacy scale can be used to assess the determinants that can increase the risks of falling among the patients. The residents after their assessment can participate in intervention groups, where balance, power and strength training programs can be conducted for 12 weeks, done 3 times every week for an average time of 30 minutes. The residents will also be frequently monitored to assess any change in their gait, posture, balance and well as their power and strength (Gschwind et al., 2013;

Scenarios for Developing and Implementing Fall Prevention Procedures

After the implementation of the policies for the prevention and reduction of risks of harm from falling, it is necessary to put in place effective evaluation, monitoring, reporting and investigative strategies. This can help to show the effectiveness of the preventative strategies in the reduction of risks of falling among elderly patients in the care facility. The strategies are outlined following the Standard 10 protocol (safetyandquality.gov.au, 2018).

These evaluation strategies include:

• Implementing and reviewing incident management systems in order to collect data related to incidents of falling, adverse events and also near misses
• Preparing reports on incidents of falls to allow monitoring and assess the safety of the patients and help to develop quality improvement initiatives
• Identification and adoption of dataset from clinical and administrative sources in order to determine the frequency as well as severity of falls
  • Using reporting template, documentation process for highlighting the data
  • Using Audit reports for the assessment of frequency and severity of falls
  • Using regular reporting systems to identify trends in the fall related incidents
• Using a strong organisation wide reporting system and investigate change management to address incidents of falls
  • Using documentation from meetings and committees on falls and harm from falls
  • Using annual reports which contains incidents of fall data
  • Using trend reports for showing the preventative changes and actions taken in the organisation
  • Reports on clinical performance shared with the governance group
  • Using medication review
  • Using registry of environmental and equipment hazards related to falls
  • Clinical records of the patients audited to understand continued management of environmental risk factors for individuals
  • Providing evaluation results to clinical staff
• Ensuring quality improvement activities
  • Using safety and quality indicators and data report
  • Using risk registers or logs which also contains activates that can address the risks of falling
  • Preparing organizational agendas, meetings or reports that show improvement through the strategies implemented
  • Including quality improvement plans, their implementation and evaluation strategies
  • Using brochures, fact sheets and posters for the workforce as residents
• For evaluation of falls prevention program:
  • Evaluation of previous device and equipments and their effectiveness
  • Outlining the types of support devices needed in the care facility and options for accessing these equipments
  • Reviews of fall incident reports to identify the role of the equipment in the incident
  • Preparing inventory of equipment and auditing its clinical use
  • Maintaining register log for use of devices and equipments
  • Implementing systems for review and procurement of devices and equipments
  • Patient environment reviews (like safety assessment and hazard removal)
• Using best practice tools for screening of patients upon presentation as well as admission when indicated at risk for falls
  • Pre admission screening tools
  • Audit of patients records
  • Observational audit of the screening process
  • Risk register and logs that contains actions to address the risks of falling
  • Evaluating patient safety and quality of care improvement plans
• Ensuring comprehensive risk assessment
  • Using policies, procedures and protocols to0 describe how risks due to falls can be assessed
  • Ensuring training and education process for the staff as well as the residents are oriented towards the reduction of falls
  • Recording the outcomes of the falls assessment for reviews
  • Providing the reports to relevant committees informing on the number of patients screened for risk of falling, and have undergone assessment for fall risk factors

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