Fall prevention presentation slides file
- 1. Johns Hopkins Fall Risk Assessment Tool (JHFRAT)
- 2. Outline •Johns Hopkins Fall Risk Assessment Tool (JHFRAT) •Case Scenario •Strategies to Prevent Patient Falls – 5 Easy Steps •Post Fall Management - SRS Handy Hints
- 3. Johns Hopkins Fall Risk Assessment Tool (JHFRAT) • Fall risk assessment needs to be standardized and ongoing. • The Agency for Healthcare Research and Quality (AHRQ) suggest that nurses should be trained to assess the fall risk (ask questions, gather information) in the same, standardized way each time they do an assessment. • Ask each patient the same key questions, that way staff will not miss any fall risk factors.
- 4. Johns Hopkins Fall Risk Assessment Tool (JHFRAT) • It is an evidence based, validated, fall risk assessment tool for adult patients. • The JHFRAT scores patients as: Low risk Moderate risk High risk
- 5. How to use the JHFRAT Please play the following video.
- 6. When To Complete The Fall Risk Assessment Inpatients: • Must have a complete falls risk assessment within four (4) hours of check-in/admission to establish the level of fall risk. Outpatients (including hemodialysis patients): • Must have a complete falls risk assessment performed by a healthcare provider during screening. Emergency Patients (EP): • Must have a complete falls risk assessment within four (4) hours of registration to establish the level of fall risk.
- 7. When To Complete The Fall Risk Reassessment Fall risk reassessment must be performed: • Within four (4) hours of each shift. • When condition changes: -Medications (sedation or general anesthesia). -Cognition status. -Mobility status. • Within four (4) hours of permanent transfer into the ward/unit. • Immediately after a fall occurs. • Post dialysis.
- 8. Johns Hopkins Fall Risk Assessment Tool
- 9. Johns Hopkins Fall Risk Assessment Tool – Auto Risk Rating • If the patient has any of the following conditions they will be classified as HIGH fall risk: • History of more than one fall within 6 months before admission. • Patient has experienced a fall during this hospitalization. • Patient is deemed high fall-risk per protocol (e.g. seizure precautions). This only applies if you have a protocol that specifies risk and/or interventions. • If the patient has the following condition they will be classified as LOW fall risk: • Complete paralysis or completely immobilized. If the patient is capable of any movement they are NOT immobile.
- 10. Johns Hopkins Fall Risk Assessment Tool - Age • Single-select. • Age is auto populated in the BESTCare.
- 11. Johns Hopkins Fall Risk Assessment Tool – Fall History • Nurses must ask patients’ for their fall history during each risk assessment. • If a patient has experienced a fall, ask how the fall happened and use this information to provide the patient with an individualized plan of care.
- 12. Johns Hopkins Fall Risk Assessment Tool - Elimination, Bowel and Urine • Single-select. • Assess the risk of urgency without considering devices (urinary catheter). • Select the choice based on observation of the patients habits and/or patient symptoms. • Ask patients about their normally stated pattern.
- 13. Johns Hopkins Fall Risk Assessment Tool - Elimination, Bowel and Urine • Frequent urination is the need to urinate more often than usual. • Do you feel you the need to pass urine more often than usual? • Frequent bowel motion is a condition in which a person passes stool more often than usual. • Do you have diarrhea or are you passing stool more often than usual? • Urinary urgency is an abrupt, strong, often overwhelming, need to urinate. • Do you feel the sudden urge to pass urine where you need to stop what you’re doing immediately just to make it to the bathroom in time? • Bowel urgency can be defined as such a strong desire to pass stool that it causes the patient to stop what they are doing and immediately have a bowel movement. • Can you make it to the bathroom in time to pass stool when you feel the urge? • Incontinence is any accidental or involuntary loss of urine from the bladder or stool from the bowel. • When you need to pass urine do you make it to the toilet in time? • When you need to pass stool do you make it to the toilet in time?
- 14. Johns Hopkins Fall Risk Assessment Tool – Medications • Single-select. • Medications that increase the risk of falls will be auto populated in the BESTCare HIS. • Nurses must review whether the patient has had a sedated procedure within past 24 hours and select the appropriate option in this category.
- 15. Johns Hopkins Fall Risk Assessment Tool - Patient Care Equipment • Single-select. • Consider all equipment that is ordered and can be used during the shift when the assessment is performed, even if it is not currently connected to the patient.
- 16. Johns Hopkins Fall Risk Assessment Tool - Mobility • Multi-select, choose all that apply. • Use information from rehabilitation services documentation to formulate the assessment. • Assign points even if impairment is corrected with visual/audio aids.
- 17. Johns Hopkins Fall Risk Assessment Tool Mobility - Unsteady Gait Assessment • Gait is best assessed by observing the patient walk. • Normal Gait: • Walks with the head erect, arms swinging freely at the side, striding without hesitation. • Unsteady Gait: • Stooped while walking. • Short steps, may shuffle the feet. • Uses furniture as a guide while walking, cannot walk without using assists. • Difficulty rising from a chair, needs to use the arms of the chair and/or several attempts to rise from the chair. • Head down, watches the ground while walking.
- 18. Johns Hopkins Fall Risk Assessment Tool - Cognition • Multi-select, choose all that apply. • Frequent assessment of level of consciousness and appropriateness of response should be considered for rating. • Altered awareness of immediate physical environment can be transient. E.g. Disorientated patients, confused patients, Dementia, Alzheimers. • Impulsive patients act on instinct, without thinking decisions through, they display behavior characterized by little or no forethought, reflection, or consideration of the consequences. • Lack of understanding of one’s physical and cognitive limitations (patients that don’t follow instructions). Beware of patients with a strong sense of independence who lack safety awareness.
- 19. Johns Hopkins Fall Risk Assessment Tool - Arabic Phrases Fall risk assessment Questions How the Nurses will Ask The Patients Arabic Phrase Did you fall down before coming to the hospital? Or past 6 months? How many times did you fall down? Fi suqoot Ow taah Qabl Yeji mustashfa? Ow qabl 6 shahar? Kam Mara Fi Suqoot Ow taah? ( 1,2,3 ) إىل دخولك قبل سقطت هل الستةاألشهر أو ؟ ى المستشف سقطت؟ مرة كمالماضية؟ Do you pass urine or pass motion before you reach the toilet? or are you rushing to the toilet because you want to pass urine or pass motion urgently? Fi Bool Ow Buraz Yjei busura'a? Ow Fi Bool Ow Buraz Yjei Qabl Rouh hamam? وصو قبل ز ر تتب او تتبول هل إىل لك الحمام إىل تندفع أنك أم الحمام؟ بش ز ر التباو التبول تريد ألنك كل عاجل؟ Do you required an assistive device for mobility? Yehtaj Musa'adah Bl Mashi ? Ow Yehtaj Wahid Ysa'adik Bl Mashi مساعد جهاز إىل بحاجة أنت هل ؟ ي للمش Do you have any visual or hearing impairment? Fi Mushkelah shoof? Ow Fi Mushkelah Ysma'a? ي سمع أو برصي ضعف أي لديك هل ؟
- 20. Case Scenario Read the scenario below and answer the following related questions from 1 to 7. Mr. A is a 72 years old man, admitted via E.R., complaining of left hip pain, due to a fall 2 days ago at home. He walks with his head down, watching the ground, and usually walks with a cane. His history includes Diabetes, Benign Prostatic Hypertrophy, and is post CABG 3 years, on aspirin once a day only. He is incontinent. In E.R. a foleys catheter FR 16 was inserted, draining concentrated urine. Mr. A was transferred to the ward for further management. During his admission assessment, Mr. A was connected to a cardiac monitor. A new order of IV fluid 0.45% saline via an IV to be commenced. His vital signs are as follows: • BP 167/72 • Pulse 91 • Respirations 14 • Oxygen saturations are 97% in room air • Pain score is 3/10 • GCS 14/15 **due to confusion
- 21. Case Scenario Please complete the Johns Hopkins fall risk assessment for the patient. 1.Age (single-select) 60 - 69 years (1 point) 70 -79 years (2 points) greater than or equal to 80 years (3 points) 2.Fall History (single-select) One fall within 6 months before admission (5 points) No fall within 6 months before admission (0 point) 3.Elimination, Bowel and Urine (single-select) Incontinence (2 points) Urgency or frequency (2 points) Urgency/frequency and incontinence (4 points) 4.Medications: Includes PCA/opiates, anticonvulsants, anti-hypertensives, diuretics, hypnotics, laxatives, sedatives, and psychotropics (single-select) On 1 high fall risk drug (3 points) On 2 or more high fall risk drugs (5 points) Sedated procedure within past 24 hours (7 points)
- 22. Case Scenario 5.Patient Care Equipment: Any equipment that tethers patient (e.g., IV infusion, chest tube, indwelling catheter, SCDs, etc.) (single- select) One present (1 point) Two present (2 points) 3 or more present (3 points) 6.Mobility (multi-select; choose all that apply and add points together) Requires assistance or supervision for mobility, transfer, or ambulation (2 points) Unsteady gait (2 points) Visual or auditory impairment affecting mobility (2 points) 7.Cognition (multi-select; choose all that apply and add points together) Altered awareness of immediate physical environment (1 point) Impulsive (2 points) Lack of understanding of one's physical and cognitive limitations (4 points)
- 23. Case Scenario Now calculate Mr. A’s level of fall risk, then proceed to the next slide for the correct answer. Tool Scoring: 0-5 points = Low fall risk 6-13 Total Points = Moderate fall risk >13 Total Points = High fall risk
- 24. Case Scenario Fall Risk Score Based on the fall risk assessment (total score is 20) Mr. A is considered at high risk for falls.
- 25. Strategies to Prevent Patient Falls – 5 Easy Steps 1. Accurate Fall Risk Assessment 2. Nursing Interventions (APP 1430-05 Appendix D) Low Moderate High 3. Patient/Family Education 4. Integrated Plan of Care (Inpatient population) 5. Referrals (Inpatient population) APP 1430-05 Falls Risk Prevention and Management
- 26. Fall Risk Identification Signs Moderate Fall Risk High Fall Risk A fall risk sign must be displayed at the head of patients bed, stretchers and wheelchairs during transport, based on the patients identified level of fall risk. APP 1430-05 Appendix I and J
- 27. Post Fall Management – SRS Handy Hints • Complete a safety report in the Safety Reporting System (SRS). • The brief factual description should describe how the fall event occurred. • Brief factual description of how the patient fell. Type of fall (accidental, anticipated physiological, unanticipated physiological, developmental, baby drop etc.) • Did the patient trip over something? • Was the floor wet? • Did the patient lose their balance, feel dizzy? • How did they fall? E.g. fell from the bed due to side rails being left down. • What were they trying to do?
- 28. Post Fall Management – SRS Handy Hints • Safety precautions at the time of the incident must be documented comprehensively in the SRS to support fall event analyses. Bed alarms alert health care personnel when a patient rises from a chair or bed and are intended to prevent falls. These devices are not the same as a call bell.
- 29. APP 1430-05 Falls Risk Prevention and Management • To successfully complete this learning program, kindly ensure you have studied the APP as its contents are essential reading prior to taking the exam. • http://app.ngha.med/Client/appview.aspx?id=9103
- 30. References Agency Healthcare Research and Quality. (2019). Preventing falls in hospitals. Retrieved from: https://www.ahrq.gov/patient-safety/settings/hospital/fall- prevention/toolkit/index.html Ministry of National Guard Health Affairs. (2022). APP 1430-05 Falls Risk Prevention and Management. Retrieved from: http://app.ngha.med/Client/appview.aspx?id=9103 National Database of Nursing Quality Indicators. (2020). Guidelines on Patient Falls Indicator. Retrieved from: https://members.nursingquality.org/NDNQIPortal/Documents/General/Guidelines% 20- %20PatientFalls.pdf?linkid=s0_f776_m73_m230_a0_m236_a0_m242_a0#:~:text=ND NQI%20counts%20only%20falls%20that,this%20is%20considered%20a%20fall