2.6 Safety Flashcards
Falls
Falls
Leading cause of injury death over 65 yr
1 out of 3 adults 65+ fall each year
Most common cause of traumatic brain injury
In 2000 medical costs of falls over $19 billion
“Fallophobia” changes lives
Factors r/t falls and injury in elderly
Intrinsic?
Intrinsic
- limited mobility
- decreased vision
- confusion
- orthostatic hypotension
- medication effects
- decreased equilibrium
- decreased reaction time
- decreased strength
Factors r/t falls and injury in elderly
Extrinsic?
Extrinsic
- unfamiliar environment
- poor lighting
- clutter/rugs
- loose shoes
- restraint use
- lack of handrails or supportive aids
- no phone, can’t see numbers
- smoking
- stove left on
Hester-Davis fall scale EPIC
8 risk categories
Last known fall Mobility Medications Mental status/LOC/awareness Toileting needs Volume/electrolyte status Communication/sensory Behavior
Hester-Davis fall scale scores
7-10 low risk
11-14 medium risk
15+ high risk
Can select multiple options in some categories
Don’t focus on the score- focus on the categories that put the pt at risk
What to do when a patient falls
Stay with pt and keep them down
Assess for injury
Know your agency policy
Documentation of falls and incident reports
Post-fall huddle and root cause analysis - “3 whys”
Reassess fall risk and initiate interventions
Restraints
Restraint free environment at LTC
Restraint contribute to deterioration of status
Chemical restrains
Restraints in acute care:
Indications:
-least restrictive device, ordered by doctor q 24 hr
Protocols and safety:
- know equipment, protect skin integrity
- remove and reposition, q 2 hr
Documentation:
- accurate time is critical
- meeting basic needs
- circulatory, skin status (CMTS)
Medication risks
Absorption
Distribution
Biotransformation (metabolize)
Excretion
**confusion is often the earliest sign of drug toxicity
Age related changes that create some med safety risks
Age related changes:
Chronic disease
Polypharmacy
Decrease body water= increased concentration water soluble meds
Increased body fat= prolonged effects of fat soluble drugs
Hepatic blood flow reduced= decreased first pass effect
Decrease albumin= altered binding, increased “free drug” and toxic level of protein bound drugs (more is available)
Renal excretion (highly individual)
Decreased number of receptors and binding, altered cell response
Beers criteria
ADR (adverse drug reaction) risk factors
High risk meds:
- psychotropics (antipsychotics, anxiolytics, sedative-hypnotics)
- anti inflammatory meds
- anticoagulants
Drug-drug interactions
Polypharmacy
Nonadherence
OTC, vitamins, supplements
Medication errors
60% of elderly take medications incorrectly
Polypharmacy
Living alone
Inadequate education
Inadequate finances
Medication regime understanding
Extrapyramidal reactions
Early onset:
Acute dystonia (spasm)
Parkinsonism (rigidity, tremor etc)
Akathisia (can’t stay still)
Late onset: Tardive dyskinesia (involuntary asymmetrical movements) Meds that block dopamine
Fall risk assessment
Nursing sensitive quality measure
Critical to the well being of our pt
EBP- proven tools for assessment which form basis for intervention
Morse Fall Scale assesses 7 risk areas
History of falls Secondary diagnosis Ambulatory aids Mental status IV or saline lock Gait stability Medications
Insulin reaction in elderly
What does it look like?
Speech disorder
Slurring
Confusion
Disorientation
