Result of Google search on Falls

8/20/2013 Michele B. James BSN, RN‐BC, Home Health Nurse The Home Care Network, Main Line Health Jefferson University Hospitals [email protected] Nancy...
Author: Jasper Lucas
2 downloads 0 Views 1MB Size
8/20/2013

Michele B. James BSN, RN‐BC, Home Health Nurse The Home Care Network, Main Line Health Jefferson University Hospitals [email protected] Nancy J. Kimmons BS, PT, Therapy Manager Rehab Affiliates, Main Line Health [email protected]

Result of Google search on “Falls”

1

8/20/2013

Result of Google search by Falls‐people

Does it hurt?

2

8/20/2013

Background y Falls identified as national safety goal by the  Falls identified as national safety goal by the

Joint Commission on Accreditation of  Healthcare Organizations y 2010 OASIS requirements for assessing risk of  falls with a valid, multi‐factorial tool y Opportunity to design and carry out a clinical  research project supported by MLHS

Who are we? y The Home Care Network of the Main Line 

Health System, based outside Philadelphia y Falls Committee activities:  trending,  p developed risk assessments, staff education y Co‐researchers—opportunity to participate in  MLH Nursing Research Fellowship in 2010

3

8/20/2013

Additional Resources y Agency Management y Lankenau Institute for Medical Research staff: 

librarians, administrative, IRB y Clinical educators/mentors Clinical educators/mentors y Statisticians at LIMR

Falls—what we know y Aging population, aging in place, social challenges y Impact of falls on society, individuals y Costs y Questions about accurate assessment,  Q ,

interventions, outcomes y Surveys

4

8/20/2013

What we learned—literature review y Little research done in home setting y No validated tools available in 2010 y Simplicity of use versus accuracy y Applicability to home setting Applicability to home setting y TUG—”gold standard?” y Multiple disciplines; differences in assessment 

skills

What was important to us in choosing  our topic? y Need for a validated tool y Difficulty of designing a prospective study y Cross‐disciplinary applicability between 

nursing and therapy y Impact on clinical practice at our agency y Meaningfulness: impact in patient satisfaction,  outcomes

5

8/20/2013

Our Purpose Statement y The primary purpose is to determine if the  The primary purpose is to determine if the

score on the multi‐factorial Falls Risk  Assessment  accurately identifies the risk of  falls in a homebound client.  y In addition, we examined if any individual item  had a higher correlation with the incidence of  falls. 

Hypothesis yThere is a positive relationship 

between an elevated score of  combined factors and incidence of  f ll falls occurring in the home. i i th h

6

8/20/2013

Our Process y Define the problem:  what is a fall? Define the problem: what is a fall?

Our Process y A fall is defined as an event resulting in a  A fall is defined as an event resulting in a

person coming to rest unintentionally on the  ground or other lower level, and not as a result  of a major intrinsic event (e.g. stroke, syncope)  or overwhelming hazard; an overwhelming  h hazard was defined as a hazard that could have  d d f d h d h ld h resulted in a fall by the youngest, healthiest  people (Tinetti, Speechley, Ginter, 1988). 

7

8/20/2013

Our Process y Identifying subjects:  100 fallers, 25 non‐fallers y Design of data collection tools, refining process y Collecting data—method y Assessing the assessment (limitation of 

software—could complete without answering  all the questions)

Data Collection Tool Falls Risk Assessment in /ROC OASIS-C—indicate score Level of consciousness/mental status History of falls

Score

NA Comments

Ambulation/Elimination status Vision status Timed Up and Go Gait and Balance Orthostatic changes Medications Predisposing diseases Equipment Issues Total score

8

8/20/2013

Disciplinary involvement Co-ordination/Referrals

Yes

No

NA

Nursing or ST: PT ordered at referral or added by SN if high Falls Risk is identified. PT or ST: SN referral ordered if score in combined Ambulation/elimination and Medication sections is 4 or above. Fall risk noted on home health aide POC

Barriers/speed bumps y y New software system in 2011! y Event reports on paper—identifying subjects 

was tedious, reports not complete or accurate  in some cases y Finding time to work on the project y Elusive resources (statistician, fellowship  leadership) y Late request to add comparative group of non‐ fallers

9

8/20/2013

Progress y Effective mentorship was found Effective mentorship was found y Data was collected eventually y New statistician—useful analysis

Results y Fallers and non fallers had mean scores  Fallers and non‐fallers had mean scores

indicating high falls risk y Fallers’ scores were significantly higher than  non‐fallers

10

8/20/2013

Mean scores

Fallers

N

Mean Score p-value

100

14.61

Non-Fallers Non Fallers 25

12 52 12.52

Difference

2.09

0.035

Significant Variables y All variables were significant All variables were significant y No single variable was highly correlated with a 

fall

11

8/20/2013

No single variable…

Variable

Coefficient

p­value

Level of Consciousness

0.99793