Fall Liability (Continued from page 22)
care plans goals; interventions and implementation in terms of achieved resident outcomes and as- sessing the need to modify the care plan (i.e., change interventions) based on changes in the resident’s status, either improvement or de- cline.
periodically on a form known as the Minimum Data Set (MDS).6
The assessment is done initially and This form
is used for many statistical and clinical purposes. It consists of a comprehen- sive assessment of a resident’s physical, cognitive, social, behavioral, ability to be independent, wounds and a variety of other functional data. This form is com- pleted by multiple disciplines including nurses, therapists, social workers and others. Although there is no specific part that deals specifically with falls, if vari- ous risk factors and events occur or are likely to occur, it “triggers” an additional assessment known as a Resident Assess- ment Protocol (RAP). Many states have
6
h t t p : / / w w w . c m s . h h s . g o v / Nur s ingHomeQua l i t y Ini t s / 2 0 _
NHQIMDS2.0.asp
developed their own guidelines for fall risk assessment once a RAP is triggered. The RAP for falls provides a systematic approach to the evaluation of a fall and assessment guidelines to assist staff in identifying common fall risk factors and developing care plan interventions.7
The
Center for Medicare Services’ (CMS’) RAP form lists the following as risk of initial falls or potential for additional falls: • Fell in past 30 days • Fell in past 31-180 days • Wandering • Dizziness • Use of Trunk Restraint • Use of Anti-anxiety Drugs • Use of Anti-depressant Drugs
Further examination into the possible risks of falls must be made by evaluat- ing the internal risk factors and external risk factors.
Internal risk factors include: • Cardiovascular • Neuromuscular (loss of arm and leg movement, decline in functional
status, Incontinence, hypotension, CVA, hemiplegia/hemiparesis, Parkinson’s, seizure disorder, syn- cope, unsteady gait and other acute and chronic conditions)
• Orthopedic (joint pain, arthritis, fracture of hip, missing limb, os- teoporosis)
• Perceptual (impaired hearing, im- paired vision, dizziness/ vertigo
• Psychiatric or Cognitive (delirium, decline in cognitive skills, manic depression, Alzheimer’s, other de- mentia)
External Risk factors include: • Medications (psychotropic, cardio- vascular and diuretics)
• Appliances/ Devices (pacemaker, prosthetics, cane/walkers/crutch, restraints)
7
CMS‘s RAI Version 2.0 Manual, Appendix C {11. Falls} Revised—December 2002
• Environmental/Situational Haz- ards and Circumstances of Recent Falls (glare, illumination, slippery floors, uneven surfaces, carpets, foreign objects, lack of handrails, new arrangement of objects, recent move-in, proximity to aggressive resident, time of day, time since meal, type of activity, standing still/ walking, reaching, bladder/bowel urgency)
Once the internal and external risk
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factors are determined, an individual- ized plan needs to be devised for each resident. This may also involve the resident’s physician, especially if there are medications. The American Geriatric Society has developed Guidelines for the Prevention of Falls in Older Persons.8 The guidelines as well as information obtained on the MDS, RAP and infor- mation from the family and other health care providers should provide enough data to develop a care plan that reduces the risk of falls or serious personal in- jury. Many facilities have developed their own checklist or scoring tools for fall risk
(Continued on page 26)
Journal of the American Geriatric Society, JAGS 49:664-672, 2001
Summer 2007
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