Best Practices in Care for Older Adults: Nursing Assistants Session 6

1. Best Practices in Care for Older Adults:Nursing Assistants Session 6 ELDER Project Fairfield University School of Nursing Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

2. Session 6 Topics: Falls And Physical Restraint Reduction For Older Adults Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

3. Topic 1: Falls Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

4. What is a fall at your agency? • If it is seen or not seen by someone who works at the agency? • What if you help them to the floor? Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

5. Falls • Falls are the number one cause of accidental death in older adults • For older adults, 1 out of 7 falls results in a broken bone • For those over age 75 who break a hip because of a fall, half will die within one year Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

6. Who falls? • About 1/3 of older adults living in the community fall each year • About 60-70% of nursing home residents fall each year • About 40% of nursing home admissions are related to falls and unsteady gait Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

7. Good news…. • A fall does not always mean injury for an older adult Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

8. Risk factors that may lead to falls for older adults: • Memory changes • Medications • Changes in how they walk and balance • Use of canes and walkers • History of falls • Incontinence • Cluttered rooms • Changes in vision and hearing • Alcohol use • Low blood pressure • Depression Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

9. What to tell the nurse when a patient falls: • What they were doing when they fell • What time of day they fell • If they felt different just before they fell • Where they fell • If anyone else saw them fall • What they patient says after the fall Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

10. What can you do? • Make sure eye glasses and hearing aides are on and working • Keep room well lit • Remove any clutter from the room • Make sure walkers and canes are nearby • Report any changes you see to the nurse • patient is unsteady and was not before • patient complains of being dizzy • blood pressure low Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

11. What can you do? • Take the patient to the bathroom every one to two hours to avoid incontinence • Talk to the older adult about falls, and how to prevent them • Make sure shoes fit well • Use bed and chair alarms as needed Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

12. Topic 2: Physical Restraint Reduction Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

13. Types of Physical Restraints: • Wrist and leg restraints • Wheelchair safety bars • Vest restraints • Mitts • Chairs with lapboards • Beds with siderails • Bedsheets Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

14. Are we using restraints? • What is your policy here? • Goal is to use restraints as little as possible Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

15. Which Older Adults Are Most At Risk For Being Restrained? • Unsteady gait • History of falls • Severe illness (medical or psychiatric) • Memory changes • Recent surgery • Medical equipment in their way (IV lines) • People who wander Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

16. Myths and Facts About Physical Restraint Use • Myth: The older adult should be restrained because they are most likely to fall and injure themselves Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

17. FACT: • Restraints do not lower the risks of falls and serious injuries Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

18. Myth: • We use restraints because they protect the patient from harm Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

19. FACT: • Physical restraints may cause harm • Physical restraints places older adults at risk for short and long term physical, psychological, and behavioral problems Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

20. Myth: • If we don’t restrain patients, and they fall, the facility will be sued. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

21. FACT: • There are laws that limit how and when we can use restraints for patients. • JCAHO guidelines limit use of restraints Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

22. Myth: • Older adults are not really bothered by restraints Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

23. FACT: • Interviews with restrained older adults have shown that they feel: • Anger and fear • Embarrassment and sadness • Hopeless • Uncomfortable Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

24. Myth: • Low staffing causes the need for restraints Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

25. FACT: • Many facilities have lowered or stopped using restraints without having more staff • Restrained patients need more time for care: • Checking and taking off restraints • Checking skin and how they are doing Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

26. What can happen to the patient who has restraints ? • They may: • get very warm • have incontinence • get pressure ulcers • get pneumonia or other infections • lose their appetite • get constipation • get strangled by the restraint Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

27. What is an Environmental Restraint? • Putting a person in a separate area where they cannot get out • Example: a room or a garden with gates Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

28. What can you do? • Use canes and walkers as needed • Use bed or chair alarms • Tell the nurse if they are having trouble with unsteady gait • Tell the nurse if a patient is acting out or pulling at their tubes or dressings • Use of service animals at some facilities Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

29. What can you do? • Tell the family how important their visits are • See if the family has any ideas about why the patient may be acting out Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

30. Bottom Line: • It is best not to use restraints. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

31. Reference The content covered in this presentation is provided by the John A. Hartford Foundation Institute for Geriatric Nursing (2001, 2003) Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

32. Reference: • Some of the material in this presentation obtained and graciously shared by: Mather LifeWays, 2003 Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858

33. Power Point Presentation Created by: Kathy Saracino, MSN, RN, CWOCN Fairfield University School of Nursing ELDER Project Education Coordinator Diana R. Mager, CRN, MSN Fairfield University School of Nursing ELDER Project Director 2007 Supported by DHHS/HRSA/BHPr/Division of Nursing Grant#D62HP06858