Page 62 nursing.elitecme.com Complete Your CE Test Online - Click Here Centers for Disease Control and Prevention National Center for Injury Prevention and Control Algorithm for Fall Risk Assessment & Interventions Low Risk Moderate Risk High Risk Conduct multifactorial risk assessment • Review Stay Independent brochure • Falls history • Physical exam including: - Postural dizziness/ postural hypotension - Medication review - Cognitive screen - Feet & footwear - Use of mobility aids - Visual acuity check HIGH RISK Individualized fall interventions • Educate patient • Vitamin D +/- calcium • Refer to PT to enhance functional mobility & improve strength & balance • Manage & monitor hypotension • Modify medications • Address foot problems • Optimize vision • Optimize home safety Follow up with HIGH RISK patient within 30 days • Review care plan • Assess & encourage fall risk reduction behaviors • Discuss & address barriers to adherence ———— Transition to maintenance exercise program when patient is ready Patient completes Stay Independent brochure Gait, strength or balance problem YES to any key question Screen for falls and/or fall risk Patient answers YES to any key question: • Fell in past year? If YES ask, - How many times? and, - Were you injured? • Feels unsteady when standing or walking? • Worries about falling? Injury No injury 1 fall 0 falls MODERATE RISK Individualized fall interventions • Educate patient • Review & modify medications • Vitamin D +/- calcium • Refer to PT to improve gait, strength & balance or refer to a community fall prevention program LOW RISK Individualized fall interventions • Educate patient • Vitamin D +/- calcium • Refer for strength & balance exercise (community exercise or fall prevention program) NO to all key questions No gait, strength or balance problems* ≥ 2 falls Evaluate gait, strength & balance • Timed Up & Go (recommended) • 30 Second Chair Stand (optional) • 4 Stage Balance Test (optional) *For these patients, consider additional risk assessment (e.g., medication review, cognitive screen, syncope) Although it is not a falls assessment model, the HRO model can provide guidelines for developing any component of the safety process in healthcare organizations. The following is a summary of the five traits of HRO with some additional information applying to healthcare (Gamble, 2013): 1. HROs are sensitive to operations. This means that both leaders and staff members must be constantly alert to how the organization’s systems and processes affect the culture of safety and, indeed, of all operations. They should never assume anything or become complacent. They need to know what does, and what does not, work. Such constant evaluation means that systems and processes are constantly being reviewed and revised. Leaders of an organization must become more transparent. The more employees know, the more they will pay attention, and the more they will strive to improve the workplace. Executive level staff, as well as middle managers, should make organizational rounds on a regular basis and ask staff members, “What can we do to improve safety?” Do you see anything that concerns you about patient care?” Nursing consideration: It is not enough to ask employees questions. Leadership must act on the information they receive and let employees know how their input has improved patient care and safety. 2. HROs are reluctant to accept “simple” explanations for problems. Accepting the surface explanation may save time and encourage complacency. However, it is important to “dig” deeply into what actually causes problems. It is imperative that one person or a group of persons not be blamed for a particular problem. In all likelihood, errors and problems can be traced to faulty, inadequate, or outdated systems and processes. Healthcare leaders should regularly examine current research data for best practice evidence and determine how their own organizations function with this evidence in mind. Evidence should be used to evaluate organizational effectiveness and make changes as appropriate. HROs conduct such monitoring on an ongoing basis. 3. HROs are preoccupied with failure. At first glance, this sounds like a contradiction of priorities. However, if all employees (not just management) are encouraged to think of ways that current organization systems and processes might contribute to errors and safety violations, they will also think of ways to enhance the