Implementing and sustaining evidence-based practices in long-term care.

Falls Prevention and Management

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    Preventing Falls and Reducing Injury from Falls (3rd ed.) replaces the RNAO (2011) BPG Prevention of Falls and Fall Injuries in the Older Adult, which was originally published in 2002 and then revised in 2005 and 2011. Whereas previous editions focused on older adults in hospital and long-term-care settings, the scope of this third edition has been expanded to include in all adults (>18 years) at risk for falls and receiving care from nurses and other health-care providers across the health-care continuum, including those living in the community.

    The purpose of this guideline is to outline evidence-based approaches for preventing falls and reducing fall injuries for adults. Recommendations are provided at the following three levels:

    • Practice recommendations are directed primarily toward nurses who provide direct clinical care to adults at risk for falls across the continuum of care, including (but not limited to): primary care, home care, hospital care, and long-term care settings. The secondary audience of the practice recommendations includes other members of the interprofessional team who collaborate with nurses to provide comprehensive care. All of the recommendations are applicable to the scope of practice of registered nurses and nurse practitioners (general and extended classes); however, many are also applicable to other health-care providers.
    • Education recommendations are directed at individuals and organizations responsible for the education of healthcare providers, such as educators, quality improvement teams, managers, administrators, academic institutions, and professional organizations.
    • Organization and policy recommendations are directed at those managers, administrators, and policy-makers responsible for developing policy or securing the supports required within health-care organizations that enable the implementation of best practices. For optimal effectiveness, recommendations in these three areas should be implemented together.

    Registered Nurses’ Association of Ontario.  (2017).  RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (Third Ed.).  Toronto, ON: Registered Nurses’ Association of Ontario. )

    http://rnao.ca/bpg/guidelines/prevention-falls-and-fall-injuries

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    This document contains sample program objectives, policy, procedures, staff training materials and tools related to fall prevention. (Member login is not required. The documents may be accessed by scrolling to the bottom of page.)

    Ontario Association of Non-profit homes and services for seniors. (2011) OANHSS LTCHA Implementation Member Support Project. Fall Prevention and Management Program: Policy, Procedures and Training Package

    Copyright 2011.

    Source: Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS). Revised: March 2011. http://www.oanhss.org

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    Table 13 provides a summary of related approaches and tools for assessing fall risk. The tools are categorized as follows: gait and balance; general fall risk and fear of falls. It is important for the organization to review the findings to support selection of tools for settings and population(s) served noting that other tools are available that address specific risk factors.

    Reference: Registered Nurses’ Association of Ontario. (2017). Preventing Falls and Reducing Injury from Falls (3rd ed.). Toronto, ON

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    Berg Balance Scale rates a resident’s balance, and  can be used to help determine resident fall risk.

    Copyright: Ameircan Academy of Health and Fitness. All rights reserved.

    Website: http://www.aahf.info

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    This is an easy to read 2-page information sheet dispelling some of the myths with bone health. 

    Best practice in LTC initiative Central South and the Long-Term Care Resource Central Hamilton. (January 2008). BP Blogger: Myth Busting: The Bone Issue, 3(1). Retrieved from http://www.rgpc.ca/

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    This Article evaluates the Care Rounds initiative and highlights its effectiveness in ensuring patient safety.

    Reference: Care Round initiative supports patient safety. November 2012. Queen Elizabeth Hospital. University Hospitals Birmingham. NHS Foundation Trust. Retrieved from http://www.uhb.nhs.uk/news/care-round-initiative-supports-patient-safety.htm

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    This table lists common components of universal falls precautions that health care organizations can determine which precautions are applicable to their setting.

    Reference: Registered Nurses’ Association of Ontario. (2017). Preventing Falls and Reducing Injury from Falls (3rd ed.). Toronto, ON

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    Table 18 summarizes different approaches to exercise and physical training interventions with varying degrees of effectiveness.

    Reference: Registered Nurses’ Association of Ontario. (2017). Preventing Falls and Reducing Injury from Falls (3rd ed.). Toronto, ON

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    The tool reviews the extrinsic and intrinsic risk factors for falls, as well as stratgeies for the development of a fall intervention program.

    Iowa Geriatric Education Center and University of Iowa. Scgilling, M. and Mulhansen, P. Info-Connect pamphlets. Fall Prevention. Retrieved from: http://www.healthcare.uiowa.edu/IGEC/publications/infoconnect

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    Fallsloop is an online communication platform for the virtual Falls community of practice. Practitioners, caregivers, researchers, older adult groups and policy planners working for the health and care of older adults come together to exchange information on prevention of falls and fall-related injuries, to support and learn from one another and to develop

    Reference: The Ontario Neurotrauma Foundation (ONF). Fall Prevention Community of Practice Loop. Retrieved from www.fallsloop.com