Active, Independent and Upright_©

A team of residents, families, staff and management at Hibernian Nursing Home, part of the BallyCara Village of Friends, Queensland collaborated and developed a falls management program as an integral part of providing a supporting environment that facilitates resident independence and aims to improve the quality of life for residents.

Background

Since February 2007 the team developed a program that achieved a reduction in falls rate of more than 50 per cent.  This is an unprecedented achievement and can be benchmarked in falls management and prevention.

Assessing resident needs
Residents and their families are the key decision makers and take part in the monthly falls prevention forums.  The team uses a valid and nationally recommended falls risk assessment tool to identify the risk of falling.

Trained staff
Staff are trained in the falls prevention program and the program is tailored to the needs of the Hibernian Nursing Home by Health and Ageing Solutions, a falls management consultancy.

The process of assessing resident needs is accurate and thorough. Staff flag fall risks and are trained with the knowledge needed to prevent falls.

Incident reporting
The system of incident reporting against the World Health Organisation’s definition of a fall^[1], uses the nationally standardised minimum data set ^[2] and external scrutiny of our program is a process of which Hibernian Nursing Home residents, their families, staff and management are proud of.

So how does Hibernian Nursing Home prevent falls?

Strategies for preventing falls

The home prevent falls through the coordinated action of our multidisciplinary team with the support of good systems and activities that support falls prevention interventions.  They act on modifying a person’s intrinsic and extrinsic risk factors for falling.

Some examples include but are not limited to:

• Activity programs that improve people’s balance and mobility (Healthy ageing, Chair exercises, Walks)and they measure the outcomes using the standardised age matched Timed Up and Go (TUG) score or Berg Balance Scale. Certificates of achievement are given to residents whose TUG’s have improved.
• Implementation of the Otago Exercise Program for all existing and new residents (as clinically indicated) – this program has been shown to prevent falls^[3].
• Resident Medication Management Reviews (RMMR’s) have been undertaken and importantly, GP’s have modified medications to reduce psychotropic medications where possible.
• Sun exposure program to improve Vitamin D synthesis – morning and afternoon tea (weather permitting).
• Falls prevention Competency pack implemented.
• Cleaning cloths for glasses obtained and supplied to optimise resident’s vision.
• Picture Care Plan revised and updated to reflect interventions regarding falls prevention.
• “Welcome to your new home” information guides developed and include brochures on vision, hip protectors, bladder problems, information on sun exposure program and how/when residents get an activities calendar. These are given to new residents on admission and placed into their Otago Exercise Program pack.
• Pedometers purchased for residents to use for the “10000 steps program.” This program is used to encourage residents to walk more.
• Footwear audit and advice literature supplied to residents.

Hibernian Nursing Home staff, management, families and residents are committed to the growth, development and ongoing evaluation of Active, Independent and Upright_©. The program was developed through collaboration of Board and Management to staff, residents, families, health professionals and this is the key to the program’s success. Everyone has been part of the process for developing this program and implementing the activities to prevent falls and improving the quality of care for residents. 

Everyone at Hibernian Nursing Home welcome the opportunity to benchmark their success in an open forum.

References

1. World Health Organisation. Definition of a fall.   [cited June 2008]; Available from: http://www.who.int/violence_injury_prevention/other_injury/falls/en/index.html.
2. Australian Council for Safety and Quality in Health Care, Preventing falls and harm from falls. Best practice guidleines for Australian hospitals and residential aged care facilities., D.o.H.a. Ageing, Editor. 2005: Canberra.
3. Campbell A and Robertson M, Randomised controlled trial of a general practice program of home based exercise (The Otago Exercise Program) to prevent falls in elderly women. British Medical Journal 1997. 315: p. 1065-9