Guest Columns

Fall prevention and protection from injury: A global challenge

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Martie L. Moore, RN, MAOM, CPHQ
Martie L. Moore, RN, MAOM, CPHQ

Research indicates that every second of every day, an older adult around the world falls and sustains injury. In a care setting, a fall is even more so troublesome.

Working with health systems in Europe recently, I had the opportunity to explore universal challenges, actions and learnings. We agreed upon the definitions of falls.

1.  Physiological (anticipated). Most in-hospital falls belong to this category. These are falls that occur in patients who have risk factors for falls that can be identified in advance, such as altered mental status, abnormal gait, frequent toileting needs or high-risk medications

2.  Physiological (unanticipated). These are falls that occur in a patient who is otherwise a low fall risk, because of an event whose timing could not be anticipated, such as a seizure, stroke or syncopal episode.

3.  Accidental. These falls occur in otherwise low-risk patients due to an environmental hazard. Improving environmental safety will help reduce fall risk in these patients but is helpful for all patients

Collecting data and debriefing all falls is underway, but like here in the United States, each health system is at a different level in its ability to analyze and use data for improvement to its plans.

There is agreement that fall prevention and protection from injury does not have a silver bullet, and there is not one action that will stop a fall from occurring. The challenges are multifocal and so must be the solutions in order to achieve reductions in injuries and deaths.

Interestingly, some of the health centers in Europe have focused on sleep hygiene programs with some positive preliminary results in injury reduction.  Increased focus on incontinence management with pelvic floor muscle strengthening also has some intriguing results.

Muscle strengthening workshops are being held in community centers to help with functional mobility. During the training, they also teach how to fall. Interestingly, the workshops are not what you think. Workshops are clinic appointments held with mobile therapist who provide the therapy and training in the space the person is living.  They teach them how to navigate their environment. They also perform fall risk assessments of the physical space to assess for needed safety equipment such as more handrails, lighted commode seating, voice activated safety alarms and other types of safety prevention.

Visual cueing of who is at risk with communication of individual risk factors for a fall remains an issue amongst care providers. There was keen interest in the tools utilized within U.S. care settings and specifically the use of posters, magnets, colored slippers, blankets and/or clothing.

Using the statement of “Many Hands — One Team,” we discussed that it takes a team to reduce falls. Everyone must be part of the fall prevention and protection from injury plan. Safety must be the first priority.  Creating knowledge regarding fall prevention and protection from injury strategies must go beyond nursing.

Aging simulation experience

One organization wanted me to experience its way of creating knowledge first hand. They dressed me in their “aged simulation experience” equipment.

They use the equipment to help their employees understand what it is like to be elderly. The goal is to evoke empathy, but also broaden the understanding of the “why” behind safety issues for the elderly.  I wore the simulation equipment for approximately 45 minutes.  Here is what I learned:

1.  My handwriting changed. It shocked me that when I looked at it later, it was my 87 year old father's current handwriting.

2.  My center of gravity shifted in such a way that when I arose or walked, I stumbled and could not recover my movements as easily.

3.  Moving my body became physically tiring and as I fatigued, my movements became less coordinated and clumsier.

Through the simulation, I became acutely aware of how much of a fall risk I was, and started contemplating how much I would injure myself if I fell to the concrete floor while wearing the equipment. I wondered how much my colleagues in the room understood how I was feeling and whether they would respond quickly if I went down. It was a powerful movement.

Martie Moore, RN, MAOM, CPHQ, is the chief nursing officer at Medline Industries Inc. and a corporate advisory council member for the National Pressure Ulcer Advisory Panel.

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