Thursday Thirteen Edition #11

13 positive features of an Assisted Living
1. You are greeted within seconds of entering the facility in a professional manner.
2. The facility smells clean.
3. Residents are involved with their surroundings and not just sitting.
4. There is a posted Activity calendar and you observe activities in progress.
5. There is a suggestion box/complaint box.
6. There is a menu that is posted in large lettering for residents to read.
7. Staff in the facility are pleasant, do not appear rushed, smile and greet you.
8. Staff interacting with residents in a friendly, caring, professional manner.
9. The facility is decorated like a home, with appropriate lighting, well maintained.
10. There is presence of an administrator, staff are visible.
11. Meal service is organized, well delivered, attractive, appetizing.
12. The outside grounds of the facility are well tended and attractive.
13. Sounds in the facility should reflect a calm comfortable atmosphere, be pleasant and inviting.

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High temperatures

This past week I came across a situation that happened several months ago, in which a resident was running a high fever 102.6 he was left alone in his apartment and was not checked on all night. He experienced a fall, laid on the floor and was not found until the next morning several hours later. The caregiver who took the resident's temperature failed to intervene by not calling the facility nurse to report the high temperature, by not assisting the resident to get his Tylenol and by not checking on the resident to see that the temperature was reduced.
Orientation and training of facility policies and appropriate protocol for staff are so critical. Had the caregiver received the orientation and training that is required the outcome for this resident may have been prevented.
Also the facility managerial staff failed to do an investigation of the fall. If the investigation had been completed it would have come to light that this employee was lacking completion of the orientation.
The investigation should have included the who, what, when where, and why of the fall, the actions of the caregiver, and an evaluation of the training of the caregiver. Development of appropriate strategies to prevent the situation from happening again was also indicated.

Thursday Thirteen Edition #10

13 suggestions for a fall risk assessment

1. History of falling
2. Cognition, mental status
3. Impulsivity
4. Vision (eye site elevated to target rather than looking at feet)
5. Ambulation ability
6. Continence
7. Use of high-risk medications
8. Use of assistive devices for transfer or ambulation
9. Attached equipment (oxygen tubing, catheters, intravenous lines)
10. Familiarity with the environment, lighting
11. Sleep patterns
12. balance, gait, footwear evaluation, appropriate shoes
13. Hydration status

This is only 13 suggestions and a thorough fall risk assessment should include additional factors that fits the make up of the facility.

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Thursday Thirteen Edition #9

13 suggestions for Post-fall assessment for the resident who isn't able to tell what happened
1. Always start with the resident and ask them to try to explain what happened.
2. Examine the resident for any skin tears, lacerations, or bleeding. After giving first aid and taking care of the immediate problem look for clues as to where the fall took place.
3. Review what the resident was wearing, clothing and footwear.
4. Conduct an environmental review looking for tripping hazards.
5. Examine the amount of light in the area.
6. Determine possible causes of why the resident was up and about if the time the fall took place was at their usual sleeping time.
7. Review what activities were in progress at the time the resident fell. Was the resident agitated?
8. Do a review of the chart to determine if there have been falls prior.
9. Was the call cord, telephone, lamp with in reaching distance of the resident?
10. Was there a night light on?
11. Has there been recent medication changes.
12. When was the last time the resident had an eye exam?
13. When was the last assesment completed that identified the resident's ability to get up on their own, their balance ability, strength or blood pressure changes?

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Thursday Thirteen Edition #8

Fall Prevention 13 guidelines
1. Safe physical environment
clear walkways of obstruction
stable furniture
easy access to items a person regularly uses
good contrast lighting helps show details and gives cues to anyone moving in the
room, floors in good repair, use footwear that promotes safe walking
2. Address medication side effects - a pharmacy consultant can review and identify
medications with drug to drug interactions that can impact the risk for falls
3. Promote mobility - exercise routinely; research has demonstrated a positive effect of exercise on reducing fall risk and increasing flexibility
4. All wheelchairs and other assistive devices should be periodically evaluated to
check for loose bolts, worn wheels, and is the device still appropriate for the
individual
5. The height of a bed, chair or toilet is crucial to safe standing, the correct
height facilitates rising by requiring less knee extension
6. Utilization of nonskid slipper socks or nonskid mat placed at the side of the bed
and/or toilet can reduce the likelihood of slipping
7. Securely fastened grab bars in the bathroom near the toilet and bathtub/shower
8. Schedule a yearly eye exam
9. Treatment of foot problems can decrease the risk of falling
10. Place a lamp next to the bed that is easy to turn on, have a night-light so you
can see where you're walking
11. Keep emergency numbers in large print near each phone
12. Slow down do not hurry, if the phone rings and they hang up, if it is important
they will call back.
13. Put a non-slip mat or self stick strips on the floor of the tub or shower

Thirteen Resources

1. "Falls in Older People" by Stephen R.Lord, Catherine Sherrington, Hylton Menz
2. e-Newsletter by Liz Taylor e-newsletter
3. "A Nursing Guide to the Prevention and Management of Falls in Geriatric Patients in Long-term Care Settings" by Deanna L.Gray-Miceli DNSc, Elizabeth Capezuti PhD, RN
4. National Institute on Aging
5. Prevent Falls
6. CDC's "What you can do to Prevent Falls" and "Home Safety Checklist" brochures for older adults
7. CDC Falls Prevention page
8. Center of Excellence for Fall Prevention
9. National Institute on Aging, AgePage: Preventing Falls and Fractures
10. The American Geriatrics society Guideline for the Prevention of Falls in Older Persons

11. Center for Healthy Aging Falls Free Electronic News
12. California Blueprint for Falls Prevention
13. National Safety Council

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Fall prevention

I have been gathering and reading articles about fall prevention for the last several weeks. On Thursday Thirteen I will write about resources that are available to prevent falls and things to keep in mind when looking at our homes to make where we live a safe environment. Please visit again on Thursday Thirteen.