Tag Archives: Falls

Risk of Falling for Elderly Nursing Care Plan

Elderly Falls and Trips

In the United Kingdom, the number of patients readmitted to hospital after treatment for a fracture had risen significantly since 2008/9.

Click here for the comprehensive falls risk assessment

Trips and falls can be a major hazard for any elderly person.  A fall can have serious and life changing implications for a patient, and the fear of falling can impact negatively on their lifestyle and the activities they enjoy.

It is vitally important that a comprehensive falls risk assessment is completed for all patients and any issues associated with, or increasing, the risks of falls are identified.

This risk assessment must be reviewed at least monthly or more regularly  if the patient’s condition changes, because any deterioration or slight changes in the patient’s condition can increase their risk of falling.

The objective of any person centred Care Plan is to ensure the patient’s issues and needs are set out in great detail and are very much at the core of the Care Plan.

The starting point is a detailed consultation with the patient and their relatives. Any issues which might increase a patient’s risk of falling are discussed and a plan to address the issues is formulated and agreed.

Many factors can increase a patient’s risk of falling, such as their mental state and the impact that may have on memory and poor or impaired eyesight.

Hearing difficulties can sometimes cause balance problems also increasing the risk.

A patient’s mobility, steadiness and gait and any issues they have with that, or an inability to ask for  help, can increase the risk of falls.

Any medication which causes drowsiness including sleeping tablets may result in  falls.

A patient’s room and day rooms must be kept clear of potential trip hazards and where possible the patient should wear well fitting shoes, and not slippers, even though they may be more comfortable.

You should consider any of these issues which are causing an increase in the risk of falling and where possible suggest or agree a plan which will address or improve the issues and record this.

Anything, however simple, that can be done to help should be recorded and implemented, such as ensuring the environment is free of clutter and ensuring a call buzzer or alarm is given to the patient.

Safety of the patient is of course paramount, and a key consideration when preparing this Care Plan.

You need to look at ways of ensuring the patient’s safety, which may involve the use of a pressure mat next to the bed to alert staff when the patient gets up, bed rails to prevent a patient falling out of bed or a lap strap in a wheelchair.

Any form of restraint must be assessed as a benefit to the patient and agreed with the patient and relative. You need to record your assessment in detail.

You need to look at any equipment which the patient will be using, such as a zimmer frame or walking aid and assess what risks they might have by using them.

When considering the issues central to a falls Care Plan, you need to strike the right balance, and look at what risks prevail in promoting and encouraging the patient’s independence, but at the same time minimise as far as possible the risks of falling.

Numbers readmitted to hospital after being sent home soars, new figures show

Thousands of elderly people are being discharged from hospital too early and left to fend for themselves, experts have warned, as new figures disclose a 70 per cent rise in readmissions after major surgery in the past decade.

Charities said the statistics reflect a “collapse” in the system of care for too many pensioners, who were being parcelled out of wards to save the NHS money, then given little care at home, placing them at risk of falls and infections.

More than 50,000 patients a year are admitted to hospital after suffering a hip fracture – one of the most common and serious medical problems for the elderly.

The new research found that the number of cases who are discharged, then readmitted as an emergency within weeks after their health worsens, has risen from 3,658 in 2001/2 to 6,810 in 2010/11 – a rise of 69 per cent.

The rise comes as NHS hospitals increasingly send patients home sooner, in an effort to cut costs.

The study found the average length of stay for hip fracture patients has fallen by almost five days over the past decade.

Charities said too many patients were being discharged too quickly, without the right help to support them at home.

Neil Duncan-Jordan, from the National Pensioners Convention said: “There are huge cracks in the system and this shows elderly people falling through them; this is about too many of the most vulnerable people being sent home from hospital too early, as the hospitals try to cut their costs, and then left to fend for themselves, without the proper care in place.”

He said too many elderly people in poor health were being failed by a “revolving door” which saw them return to hospital repeatedly, because they had not received sufficient help.

The report by independent healthcare researchers the Nuffield Trust and charity the Health Foundation, which examined NHS care between 2001/2 and 2011/12, found that the situation had worsened in most parts of the country in the last three years covered.

In 64 per cent of the country, the number of patients readmitted to hospital after treatment for a fracture had risen significantly since 2008/9, while in just seven per cent areas, there was a significant reduction.

The figures come despite promises by ministers to tackle emergency readmissions, with the introduction of a system of fines in 2011, so that hospitals are not reimbursed for the costs of treating patients after they are-admitted, if they return to hospital within 30 days of treatment.

Katherine Murphy, from the Patients Association said too many patients were being “rushed through the system” and discharged as quickly as possible to save the NHS money, despite the fact there was no support in place for them.

She said: “These are deeply concerning figures that confirm a trend that has been emerging over recent years.”

“In the modern age, with the advancements in medical technology we have seen, readmission rates should be falling, not increasing. It is our concern that patients are simply being rushed through the procedure and out of hospital as quickly as is possible, with no support in place to ensure their recovery once they are discharged.”

Colin Howie, Vice-President of the British Orthopaedic Association said: “These figures reflect a combination of factors; a shorter length of stay in hospital, a lack of social support and a more complex case-mix, with increasing numbers of elderly frail people.”

He said the finding from the study that those in the poorest areas were more likely to be readmitted to hospital as an emergency suggested that they were receiving less help in the home than more affluent groups.

The report showed a reduction in mortality for patients suffering hip fractures over the decade.

Age UK said many of the fractures could have been avoided in the first place if elderly people had been given the right help at home.

Caroline Abrahams, Charity Director, said: “All too often, older people don’t get the care they need to prevent them going into hospital in the first place, then poor care in hospital followed by poor care in the community on discharge which means they are more likely to go back into hospital again.”

Care and Support Minister Norman Lamb said:”NHS care doesn’t end after an operation. It is vital that hospitals work more closely with GPs and social care providers so patients are receiving better care when they get home.

“That is why we are investing £3.8billion in improving integration between health and care services, strengthening the role of primary care so we can keep people healthier and treat them closer to home without the need to go back to hospital.”

Source  The Telegraph

Pontypridd ‘optical illusion’ pavement blamed for falls

A £10.5m town centre make-over has been blamed for more than 20 people being taken to hospital for falls after new paving stones “hid” a pavement kerb.

The new pattern of pavers on part of Taff Street in Pontypridd has created an “optical illusion”, disguising the drop to road level, locals say.

It has led to a series of trips, mainly for elderly people, according to a shop manager who has helped many of them.

Rhondda Cynon Taf council said the regeneration had made streets safer.

The stretch of pavement on the main shopping street drops to a loading bay at road level, which has similar colour paving stones to the pavement.

It means that people – many rushing to a nearby bus stop – do not see where the kerb is.

Morfydd jenkins
Morfydd Jenkins Morfydd Jenkins says she suffered cuts and bruising to her face and neck after falling in Taff Street

The Welsh Ambulance Service said it had been called to the pavement 20 times since 1 May, when the improved streetscape was completed, all for injuries related to falls.

Cheryl Hull, manager of Shaws the Drapers, which is opposite the loading bay, says she has personally helped and called an ambulance for about 10 people in recent months, with the latest on Tuesday.

“The loading bay used to be the same colour as the road but when they did the regeneration they made the pavement and loading bay similar colours and this is what’s causing what I would say is an optical illusion. It tends to blend into one,” she said.

“Some people see the edge of the kerb but others don’t.

“Depending on what angle you come at it, it can look as if it’s all one level and I think when older people are rushing for the bus, they might not see it, especially as their eyesight tends to be bad.

“And at that age they fall quite heavily and some of the people I’ve helped have been quite badly hurt. At that age, it can really be a big deal too.”

Bruising and cuts

She said she did not feel the council had done anything wrong as there were no loose pavers or broken stones but added: “Surely they can do something to try to highlight the pavement.

“It’s such a shame as Pontypridd’s much nicer since the regeneration and it’s not good that this is distracting from the work that’s been done.”

Morfydd Jenkins, 75, from Pontyclun, Rhondda Cynon Taf, had been going to Pontypridd once a fortnight until she fell in August. Now she said she has lost confidence in going out alone.

“I was going to the bus stop and all I remember is falling over the kerb – I didn’t see it,” she said.

“The woman in Shaws took me into the shop and called an ambulance. I was taken to hospital and had X-rays and I had a lot of bruising and cuts to my face and neck.

“I’m feeling alright now but I’m much more cautious about going out on my own.”

A Rhondda Cynon Taf council spokesman said safety had been a matter of “paramount importance” throughout the regeneration, “creating a safer and more attractive environment for all town centre users”.

“Throughout the town improvements have been made removing clutter from the street, introducing more accessible floor surfaces, and introducing flat surfaces where possible which greatly assists those with mobility issues,” he said.

“There are some areas in the town that do require a kerb to ensure services such as buses and deliveries to shops can continue to be provided, and it is important that pedestrians are suitably protected from vehicles in these areas.

“Accessibility throughout Pontypridd has been greatly improved due to the regeneration scheme and with an increased amount of visitors to the town centre month-on-month, clearly the project has been a huge success.

“Recently the innovative free hire of mobility scooters and wheelchairs has been introduced, a scheme that would not have been possible previous to the regeneration project taking place. “

Source BBC News

Nurse failed to act over dementia patient’s 27 falls

A NURSE at a South Tyneside care home who failed to act after a dementia patient fell 27 times in the last two months of her life was let off with a caution.

Paula Washington admitted failing to alert a GP to the elderly resident’s condition as she deteriorated and died at St Michael’s View Care Home in South Shields.

The woman’s death was one of 16 to die at the home, which prompted an investigation by police and the prosecution of two staff members.

Washington should have referred the woman, known as Resident A, to the South Tyneside falls team, after she fell 27 times in 66 days at the home.

She also failed to update Resident A’s records and complete, and ensure, staff followed her care plans, even after the pensioner spent six days in hospital with a fractured pelvis.

Washington then failed to monitor or record the woman’s vital signs shortly before she died, the Nursing and Midwifery Council heard.

Dylan Moses, for the NMC, said: “Resident A had difficulty communicating, dementia, memory loss, and a history of falls.

“Staff did not produce an updated care plan for her, after she fell 27 times in 66 days, including five falls in her first eight days at the home. Her falls should have prompted an early referral to South Tyneside falls team, but such a referral was never made.

“When her condition deteriorated, there was no evidence to show the registrant recorded her vital signs or informed the GP. Her GP transferred her to South Tyneside District Hospital and she died later that day.”

NMC panel chairman William Ard said: “The panel considered Mrs Washington’s failures were serious. They were wide-ranging and involved areas of basic nursing care.

“These included failures to adequately complete records and care plans, failures to ensure care plans were followed by other staff, failures to act upon and escalate concerns regarding the wellbeing of patients, a failure to ensure a correct policy was in place and failures to appropriately monitor patients.

“These failures were significant and occurred over a period of time. As a result, several frail, elderly and vulnerable patients were caused severe harm.

“In terms of mitigating factors, the panel considered this occurred in a severely failing home, where there were institutionalised breaches of CQC standards and systematic failings.

“Mrs Washington has expressed genuine remorse for her acts and omissions. The panel also noted her previously unblemished lengthy career. The misconduct involved was serious. It resulted in direct harm to a number of vulnerable patients.

“The panel acknowledged that Mrs Washington has made significant attempts to rectify her misconduct.

“The panel considered whether a caution would sufficiently protect the public, given that it would not restrict Mrs Washington’s freedom to practice in any type of nursing environment.

“Having considered the remediation and reflection undertaken by Mrs Washington, and the fact that a caution order would act as a mark on her registration, and alert any potential employers to the previous misconduct during its duration, the panel was satisfied that it would”, Mr Ard added.

Resident A was admitted to St Michael’s View Care Home in September 2009, where she fell 27 times up until her death in November 2009.

Washington, who attended the central London hearing, admitted all charges against her. Her fitness to practise was found to be impaired and she was handed a four-year caution.

The nurse’s case is one of seven NMC hearings of former workers at the home, which was then run by the company Southern Cross.

Ailsa King was struck off last month for failing to care for an elderly woman who died just a fortnight after she was admitted to the home.

Johnsy Johnson was suspended in June for 12 months, for failing to give an elderly woman potentially life-saving CPR.

The Gazette revealed last week that the home, now owned by Countrywide Care Homes Ltd, is set to close.

Care employee’s catalogue of errors at home

PAULA Washington also failed to refer a second resident to the falls team despite him falling six times in just 15 days.

The man, Resident I, suffered a chest infection on October 6, 2009, yet no care plan was ever written to reflect his condition.

The next day, another nurse found Resident I was suffering from oral thrush and bruising to the coccyx area, yet Washington failed to act upon the issue.

His fluid charts were not always completed and left nameless, meaning they could have been anyone’s, the hearing heard.

Three other residents were unnecessarily given suctioning to clear airways by Washington, when she had not undergone the appropriate training.

St Michael’s View only had one catheter for the suctioning, despite catheters being intended for single use due to infection risk.

Det Insp Ian Bentham, of Northumbria Police, said when he visited St Michael’s View to investigate the deaths, both inadequate suctioning and blood pressure monitoring equipment were found.

“The suctioning equipment was found on the carpet floor and no other catheter was available,” he said.

“During our inquiry, there were an identified number of deaths from chest infections.”

One patient suctioned by Washington, ‘Resident B’, was found by a colleague to be ‘frail and ill looking’ before she died in February 2010.

Another man, Resident F, was left to be nursed in his bed for seven months without ever leaving his room, the hearing was told.

Washington also failed to ensure care plans for him were accessible to staff and failed to maintain his records adequately.

She also failed to ensure a safe environment for the man in that she did not ensure he was being turned regularly.

The nurse also failed to appropriately manage the man’s food and fluid intake and did not ensure that he was suctioned by adequately trained staff.

Source The Shields Gazette

The Crucial Role Nurse Practitioners Can Play In Treating Chronic Geriatric Conditions

U.S. residents today are living longer than previous generations, thanks to improved public health and medical treatment.

But they’re also living longer with chronic geriatric health conditions like dementia, urinary incontinence, depression and debilitating falls, which often require complex medical care.

Doctors spend significant time and resources treating individuals with chronic conditions, and the average family physician can become severely overtaxed managing care for such patients. The picture becomes even worse with chronic geriatric conditions.

Several heath care treatment models have been designed over the years to improve medical care for chronic geriatric ailments.

One model, for instance, helped improve patient care by teaming geriatricians in an academic medical center setting with nurse practitioners to co-manage care. But can the same model work in community-based primary care settings?

The answer is yes, according to a UCLA-led study published in the June issue of the Journal of the American Geriatrics Society. The study’s findings highlight the crucial role nurse practitioners can play in treating chronic geriatric conditions.

“It is becoming increasingly clear that care of chronic geriatric conditions is better when it’s done in teams,” said the study’s lead author, Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at UCLA.

“There are some things that nurse practitioners do better than doctors and some things that doctors do better than nurse practitioners.”

Reuben noted that while doctors are generally good at treating acute medical conditions and those requiring highly complex decision-making, some chronic conditions tend to be “swept by the wayside” because physicians either don’t have the time or are simply not as skilled in dealing with them.

In addition, doctors often can’t make the time to deal with both patient symptoms and the management of chronic illnesses that may not have acute symptoms. “There just isn’t enough time in the office to do both,” Reuben said.

For the current study, researchers screened 1,084 patients at two primary care facilities in Southern California for four chronic geriatric conditions: falls, urinary incontinence, dementia/Alzheimer’s disease, and depression.

Of those patients, 658 had at least one condition; 485 of the 658 patients were then randomly selected for medical review.

Of those 485 patients, 237 (49 percent) were seen by a nurse practitioner, for co-management with a primary care physician of at least one condition. The rest were seen only by a primary care physician.

The researchers examined whether a set of measures known as “quality indicators” were performed for each condition. For example, if a patient had a history of falls, did the care provider assess whether the patient might be taking medications that increase the risk of falls and assist the patient in reducing or stopping the use of that drug?

The study authors found that the percentage of quality indicators that were satisfied for patients whose cases were co-managed by a nurse practitioner and a physician was higher than for those seen only by a physician.

For falls, 80 percent of quality indicators were satisfied for co-managed cases, compared with 34 percent for physicians alone; for urinary incontinence, 66 percent of indicators were satisfied, compared with 19 percent; for dementia, 59 percent were satisfied, compared with 38 percent; and for depression, 63 percent were satisfied, compared with 60 percent.

Much of the difference was due to the fact that the nurses were likely to take far more detailed patient histories and to perform other assessments.

For instance, the pass rates – that is, whether the measure was performed – for taking a patient’s history of falls was 91 percent for co-managed cases, versus 47 percent; vision testing was 87 percent, versus 36 percent; and discussion of treatment options for urinary incontinence was 79 percent, versus 28 percent.

The findings were limited by several facts, the researchers said. Some cases that primary care physicians considered “mild” were not referred for co-management, the study was conducted in only two facilities within a single geographic area, and it was a one-time intervention with minor revisions as the study went along rather than a longer, continuous learning process.

Source Medical News Today

9,000 deaths in the uk’S over 60s through preventable falls

Around a quarter of a million people over the age of 60 every year suffer from falls that require hospital treatment and 9,000 of those will die. It’s National Falls Awareness Week and Age UK want to help prevent these accidents.

One woman in her seventies suffered a potentially life-changing fall but has now taken steps to stop it happening again. 
Music is Gill Truman’s life. She has been a musician since the age of 12 and now in her seventies spends most of her time teaching at her home in Birmingham. A few years ago she fell on a broken paving slab breaking her thigh-bone. She feared she would not be able to play properly again.
I was worried that perhaps I wouldn’t be able to play the piano or maybe play it as well and also the guitar because the guitar if you’ve got a broken leg is somewhat more difficult at least with the piano you can peddle with the other foot.
Gill TruemanGill broke her thigh bone and sustained severe bruising after falling on a broken paving slab
Gillian’s story isn’t unique a quarter of a million people over 60 every year suffer a fall that needs hospital treatment, 9,000 of those will die as a result of their injuries.
It doesn’t have to be this way you can prevent falls and often by taken simple steps. By making sure you’ve had your eyes tested making sure those carpets and rugs are really clearly tacked down in the house being really careful on the stairs but also taking exercise that doesn’t mean running the marathon it can be really simple chair based exercises that keep you fit and active all has a good positive contribution to preventing falls.
 – Michelle Mitchell, Age UK
Gillian takes part in exercise classes that help her to keep fit and build up her strength. She says these have really helped.
Gill says the classes have been a huge help and would recommend them to anyone

I recommend the classes to anyone, what you have to understand you may have lead or you may be leading an active and busy, busy life but that does not get over the fact you need exercise. I thought dashing around that would be me but no.”
The exercises might seem simple but they are one of the ways Age UK says elderly people can help prevent falls and help stop the hundreds of thousands of admissions to hospital
To find out more about Falls Awareness Week or find out what the recommended exercises from Age UK are click here.
To see how to make your home safer and reduce the risk of falling see Age UK’s checklist.

Source ITV News

Concern over elderly fall numbers

Around 350,000 older people are admitted to hospital every year as a result of a fall, a charity has warned.

Age UK said the number of people over the age of 60 who are treated in hospital in England because of falling over is a “real concern”.

About 9,000 older people die every year as the result of a fall and injuries from falls are one of the leading causes of death for over-75s, the charity said.

Launching its Falls Awareness Week, Age UK said the impact of a fall can be life-changing for an older person and can leave them feeling isolated and reluctant to leave home.

“With the older population projected to rise by nearly 50% in the next 20 years, the number of people over 60 experiencing falls to the extent where they are receiving hospital treatment is a real concern,” said charity director general Michelle Mitchell.

“Falls in later life are often dismissed as an inevitable part of growing older, however the reality is that there is something we can all do prevent a fall and increase our chances of living a healthy and independent life for as long as possible. Prevention is better than cure and more should be done to support and promote this.”

On Friday, figures from the Health and Social Care Information Centre revealed that between 2012 and 2013 more than 410,000 people of all ages were admitted to hospitals across England as a result of a fall – a 13.4% decline from 470,000 the previous year.

Almost three-quarters of females admitted were over the age of 65, compared with around half of men, the HSCIC said.

Last week health bosses were urged to take action to prevent elderly people falling over in hospital after it emerged that 90 patients died in one year because of such accidents.

Doctors and nurses must create a plan to reduce at-risk patients’ likelihood of falling while being cared for in an NHS organisation, the National Institute for Health and Care Excellence said.

Source MSN