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Proactive fall management

May 1, 2010
by Steve Elder
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Data is key to individual care plans

Electronic fall monitors have become a regular part of many facilities' fall reduction programs. They have proven to be an effective means to notify staff in a timely manner that a resident may be moving in such a way that he or she is at risk of a fall.

In a typical application, a pressure-sensing mat is place on the bed or chair and attached to a monitoring device. If the resident attempts to get up, thus changing the pressure on the mat, the monitor will alarm.

As this description reveals, fall monitors help caregivers react to a potential fall, and are very useful in this role. Now, as this technology matures and develops, facilities are starting to find ways to be more proactive in their approach to falls.

New approach

A number of factors lie behind this new approach. The Centers for Medicare & Medicaid Services (CMS) revised its State Operations Manual in August 2008 to place increased emphasis on the individual assessment of safety risks for each resident. The State Operations Manual provides guidelines for state surveyors of long-term care facilities, and being cited for an F-tag violation can jeopardize a facility's Medicare funding.

Falls are covered under F-tag 323 on Accidents. This tag requires facilities to provide an environment free of general hazards, but also to assess the individual safety risks of each resident, and put in place an appropriate care plan. This is defined as an ongoing process, whereby interventions are continually assessed for effectiveness and necessity and modified accordingly.

For facilities to meet this requirement, they need to have useful data. Assessment protocols, such as the Morse Fall Risk Assessment or Hendrich Fall Risk Assessment are designed to gather pertinent information that can indicate a risk for falls: history of falls, altered elimination (such as incontinence or nocturia), balance and gait, depression or cognitive impairment, frailty, etc.

At a glance…

A fall monitor can report a resident's pattern of mobility, how mobile he or she is, and how often the resident is getting out of bed. With the resident's behavior fully documented, it is then possible to devise-and justify-the right interventions.

Most fall prevention coordinators or facility administrators will recognize, however, that it isn't always easy to get all this information. Some factors, like balance and frailty, can be determined quickly, but others, such as nocturia, may require a long period of observation before they are detected. Still others-particularly the history of falls, which is probably the leading risk indicator-rely entirely on information provided by the family or a transferring facility; and that isn't always forthcoming.

Moreover, all this data only provides a partial understanding of the individual's actual behavior-when he or she is moving in a way that could lead to a fall. This is where fall monitors can play a vital role.

Jeff Quinlan is a medical safety device consultant and president of Medical Technologies International, based in Bothell, Washington, near Seattle. He has worked with many senior care facilities to help them fit technology into their fall reduction programs.

“What facilities are looking for is the real story: What are the residents' patterns of mobility, how mobile are they, how often are they getting out of bed?” Quinlan asks. “Facilities can have a nurse sit at the foot of the bed to get that information-which is very expensive-or facilities can use a fall monitor that records resident movement for them.”

In this application, the fall monitor records data on the individual's movements, Quinlan says, which provides direct insight into the particular behavior patterns of that resident. It may indicate that the resident is a candidate for a mobility alarm, but the results can also point in other surprising directions.

“I've had clients use this and discover a urinary tract infection. The report showed that the resident was exiting a lot at night, which typically the facility wouldn't be aware of. With the information from the monitor, they were able to diagnose the root cause very early on,” Quinlan explains.

Justification

With the resident's behavior fully documented, it is then possible to devise-and justify-the right interventions. This is an important factor that should not be overlooked. Whether the data show that the resident is or is not a candidate for use of a fall monitor or other interventions, the facility has a sound factual basis for its decision. This information can be placed in the resident's record and remains as evidence of due diligence.

This process can also be repeated regularly, as part of the facility's ongoing assessment of the unique needs of the resident. With a clear picture of the individual's actual behavior, the facility is well placed to actively prevent falls from occurring.

Steve Elder is Senior Communications Specialist for Stanley Healthcare Solutions. He has written extensively on security and safety technology for healthcare.

To send your comments to the editor, please e-mail mhrehocik@vendomegrp.com.

Long-Term Living 2010 May;59(5):28

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