Reducing Fqlls qnd lniuries...

And Mqking Life Sqfer tor Residents

ccording to research completed by the

Ontario Injury Prevention Resource

Cenhe in 2007, at least one senior visits an emergenry department every 10 minutes due

to a fall. Falls often result in serious injuries such as hip fractures and head trauma, especially when they occur in elderly, frail seniors. The annual cost of falls to Canadians is estimated at $2.8 billion. Accreditation Canada has recently added 'fall prevention'

A review of lhe reseorch lileroture ond evidence regording the use of vilomin D ond colcium omong geriolric residenls ond their effecliveness in lhe prevention of folls points lo the following: . Vilomin D is on emerging theropy in foll prevention. ll improves

muscle slrength ond funclion. The combined use of vilomin D ond colcium hos been shown lo improve body swoy ond lo reduce risk of hip ond

nonverlebrol froclure.
Sludies of vilomin D ond colcium supplemenlolion show o significonl reduclion in froclure roles in both instilutionolized ond free-living elderly people.

as one of the new required organizational practices (ROP) for accreditation by the Canadian Council on Health Services.

Recognizing
vale fbrrace Long

the enormous

challenge

of preventing falls among its residents, Cedar-

lbrm

Care Home in Toronto

lnlroduce the cycle lo leom physicions for review ond feedbock. Suggest vilomin D ond colcium supplemenlolion for newly odmitted residenis who ore deemed oppropriote by the physicion lo receive lhis theropy. . Communicole the proiec/cycle lo the odmitled residenl ond receive consenl for lreolmenl. . lnform nursing sloff obout the rolionole for vilomin D ond colcium

has joined the National Collaborative on Falls

in

Long Term Care Homes. Initiated by the College of Nurses of Ontario (CNO), the Quebec Campaign and Safer Healthcare Now! the col-

laborative involves 33 teams from across Canada. Cedarvale Terrace came on board in May 2008, setting a goal of a 25 per cent reduction in falls among residents to decrease
the number of injuries occurring in the home.

. .

supplemenlolion. Shore informolion with the residenl's fomily, substitute decision-moker ond power of ollorney. lnslilule vilomin D ond colcium supplemenlolion upon odmission (medicolion reconciliolion). Some newly odmitted residenls might be on lower dosoge of vilomin D, hence during odmission lhe dosoge is odiusted by o physicion to lhot of o lheropeulic ronge of 1000 lU. Review lhe effecliveness of lhe theropy. lnvolve lhe phormocisl wilh regords lo setting on oppropriole dosoge.

Who is involved?
The team involved in the Cedarvale Terrace initiative embraces various disciplines, including medicine, nursing, physiotherapy, reha-

Review the effectiveness of lhe vilomin D ond colcium with regords to the incidence of folls omong newly odmitted residents. Trock records regording crilicol iniuries (i.e., froclures os o resuh of folls). The stotislicol comporison of lhe number of folls is: Foll roles omong residenis pre-supplemenlotion lo foll roies recorded post-

bilitation, programming, staff education,

quality coordination, management, frontJine

supplementolion wilh vitomin

D.

nursing (personal support workers, health care aides) and housekeeping-all focused on the safety of the residents in their care.

Using the latest quality improvement model-'plan do study act'-the team was
able to test several fall prevention interventions. The Registered Nurses'Association of Ontario's best practice guideline'Prevention of Falls and Fall Injuries in the Older Adult'2 served as a guideline for all improvement

Anolyze lhe results lo see if there is o potenliol for o greoler opplicotion/ulllizotion of vitomin D ond colcium supplementolion in the foll prevention progrom. Explore furlher opporlunities to develop o Cedorvole lierrqce Geriolric Guiding Prolocol on lhe use of viiomin D ond colcium supplemenlolion. As o resuh of lhis cycle Cedorvole Terroce developed o Stondord Prolocol on vilomin D supplemenlolion.
Descriplion of o project to ossess the effeciiveness of vitomin D ond colcium supplemeniotion in preventing folls omong newly odmified residents.

initiatives.

by Jonusz Kqleto
Janusz Kaleta is the usociate nurse manager and. faII prevention team leader at Ced.arvale Terrace LongTerm Care Home inToronto.
reached
She

Currently, the medical team, pharmacy and nursing are working on finalizing protocol to provide vitamin D supplementation

Cedarvale Terrace, staff observed 50 per cent

fewer falls resulting in injuries in 2008 compared to 2007. FurtheYmore, and even
more sigfficantly, no residents at Cedarvale
Terrace suffered serious injuries such as hip

to all residents. Vitamin D is thought to be beneficial in preventing falls among

the elderly (Table 1).

canbe

at (416) 967-6949 ext. 238 or

j k aleta@ c ed ar v alet er r ac e. c a.

The results speok for themselves

As a result of the initiatives introduced at

fractures. Most of the falls that did occur resulted in no injuries or a skin tear or bruise. The total number of falls has been
Continued onpage 30

Long Term Core

Foll Prevention Through innovotion: Non-removoble Clips

These speciolly-engineered clips hove o speciol lock berween their wings, which prevenls lhem from being removed. They con be used with exisling .oli-b"ll syslems insteod of purchosing bed olorms. This moy potentiolly soie o long

Focusing on SAFE Prqctices omong Fronl line Sloff

Sofe environmenl: . At leost one bed roil down
unless

lerm core home hundreds of dollors.

. Pothwoys cleor of clutter. . Bed brokes olwoys opplied.

Assisl with mobilily:

ossessed otherwise,

. Adequole ond oppropriote lighting.

. Tronsfer/mobility

Sofe ond regulor toileting. stotus documented. Mobility oids/urinols within reoch.

Foll risk reduclion:

The rotionole for their use is os follows: ' Regulor clips ore often removed by non-comperent residenls ond ore lherefore noi effeclive in foll prevenlion. when properly used with coll-bell syslems ond/or olorms, rhese non-removoble ' clips ore sofe ond will olert stoff regording o sofety concern. ' The cosl of eoch clip is opproximotely $2, os opposed to the $g0-100 cost of o whole olorm unil.

. .

. . .
.

Coll bell within the resident's reoch. Bed in the lowesl position for the resident's need. Personol ilems reochoble. Proper footweor ovoiloble.
Discuss risk foclors.

Engoge residenl ond fomily:

Communicole muluol plon.

EXPERIENCED
We understand your business. We work with several OLTCA
members.

reducedby 22per cent. Looking to the future, the members of the interdisciplinary team remain committed to further improving the safety of residents without limiting their mobility or independence.

identify risks and prevent falls before they

can happen. LTC The author wishes to acknowled.ge the commitment t0 safety of the multidbciplinary team at
Cedarvale Tbrcace, in

particular the clients and

How fomilies con help

Families can assist in meeting safety-related

families, front-line nursing staf (RNs, RPNs, PSWs, HCAs), the medical team, rehabilitation
and. physiotherapy, administration, howekeeping and the dietary departments , vnthout whom this

RESPONSIVE
We react quickly when you need advice or a decision.

LEVERAGE
We can do the best job of advocating your interests.
Specla/isfs rn: General Liability

challenges by providing proper footwear (i.e., soft, without heels and non-slippery), participating in therapy sessions and communicating any safety-related observations to a nurse or a nurse manager. A residentfocused, collaborative effort is needed to

quality initiative would. not have matenalb,ed.

References 1. Public Health Agency of Canada, 2005. Informa-

tion Notice announcing that Fall Prevention is recognized a new Required Organizational Practice commonly known as IROPI by Accreditation
Canada.

Use o Nudge:

2. Registered Nurses'fusociation of Ontario. Preven-

property
Errors & Omissions Dhectors' & Officers' Liability

Reminders for Stqff

The use of simple nudges for stoff-such os o porticulor pen of o cerloin colour-

Employee Beneftts Group Home & Auto

tion of Falls and Fall lnjuriu in the )ld.er Adult. RNAO, 2005. Available from: urww.rnao.orgl Page.asp? PagelD= 924&ContentiD= 8 1 0. Accessed August 18, 2009.

moy remind them to re-check residenls'

sofely while signing documentotion for conducled/ scheduled sofety tosks. Further informafion
The Canadian Patient Safety Institute,

For assistance, please contact: Mona Krolak 41 6 597 4633 1 800 2322024 mona.krolak@ hubinternational.com
www. hkmb.com
. www. hubinternational.com

Cognilive reseorch ond lhe lotest developments in neuroploslicity show lhot only o smoll port of lhe informoiion lhot enlers the eyes ocluolly reoches lhe conscious oworeness. One porticulor finding hos shown o distinction between where people look ond whot they ocluolly see.

nr,vw.patientsafetyinstitute. ca. Rust TB, Wagner LM, Hoffman C, et al.. Broadening the patient safety agenda to include safety in longterm carer HealthC Q20081'l:314.
Chapuy MC, tulot ME, Duboeuf i et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Ingl.i Med 1992;327:1,63742.

Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N.Engl J Med 1,997;337:670-6.

Long Term Core