Every member of your health care team plays a vital role in Falls Prevention. There are at least 17 different health disciplines here at Women’s College Hospital (WCH) and their work spans across many of the different programs. These Health Disciplines follow the WCH Falls Prevention and Injury Reduction Policy that makes it “everyone’s responsibility to prevent falls from happening on site.”
Patients also have a role to play in falls prevention by ensuring they are safe when attending virtual appointments and in person appointments. They can do this by communicating concerns to their health care professionals and by taking the steps as indicated below.
NURSING STAFF:
Nurses in ambulatory care assess every patient for a falls risk. In Dermatology, in the specialized program “Phototherapy Education and Research Centre” program, patients are at an increased risk because the treatment requires them to wear goggles, which covers their face during treatment. Following a full assessment and orientation to treatment, the patient and nurse agree on a plan of care that keeps the patient safe by mitigating any risks for falls.
In the Peri-Anesthesia department, every patient is considered a falls risk related to the patient experience and the likelihood of receiving medications that are sedative or analgesic in nature. Prior to any procedure requiring sedation, nurses ensure that patients have an escort home and that they are not taking public transportation, as prolonged travel and delays can increase the likelihood of falls. For patients having procedures that directly impact mobility and increase the risk of falls, additional education and support are provided by nurses through collaborating with OT and/or PT on correct body mechanics, ensuring a safe home environment during recovery, and educating patients on the use of assistive devices as required. After surgical procedures, patients are monitored closely, including regular vital signs assessment and eventually trial standing and ambulation with nursing staff to be eligible for discharge. Nurses in this department also make sure that patients who have received sedation use a wheelchair when leaving the unit.
OCCUPATIONAL THERAPISTS:
Occupational Therapists are doing a lot of work in falls prevention with their patients in the different programs here at WCH. The following is a list of what an occupational therapist may discuss with a patient regarding falls:
- Reviewing the risk factors for falls and assisting the patient in identifying those risk factors that that apply to them
- Providing information on how falls occur based on demographics (eg younger patients fall usually due to inattention during time constraints whereas older ones are more due to impaired strength or sensation)
- Providing education and information on how to ameliorate risk factors such as suggestions for strength and balance, appropriate footwear and footcare, improvements to home safety, greater awareness of environmental risk factors, and behavioural strategies such as mindfulness
- Educating patients on how to manage multiple medications and possible side effects, and their impact to falls risk.
- Providing resources on Falls Prevention Programs/Strategies which can either be based in the community or in a hospital.
- Making recommendations for an in-home safety assessment by a community occupational therapist if necessary.
PHYSIOTHERAPISTS:
Physiotherapists take a detailed falls history, medication review, risk factor assessment including osteoporosis and bone health, urinary incontinence and cardiovascular disease. Additionally, they’ll conduct a physical examination including gait and balance, neurological and cognitive function, lower limb strength, visual acuity, feet and footwear. These all can contribute to a fall.
A Functional assessment such as activities of daily living, functional ability, and fear of falling will be part of the physiotherapy assessment.
Some of the physiotherapy goals are:
- Prevention of further falls by working on mobility by incorporating an exercise program. Strength and balance have been shown to have the most effective outcomes in reduction of falls rated. The Physiotherapist will develop a tailored exercise program based on the specific needs of a patient.
- Ensuring the person’s living environment is as safe as possible by incorporating education on safety strategies and or a referral to an Occupational Therapist
- Restoring/improving self-confidence and self- esteem, which might have a positive impact on patient’s quality of life.
A self-directed home exercise program will be provided for continuity of strength and balance, and other resources that will ensure and reduce future falls.
PULMONARY FUNCTION TECHNOLOGISTS AND RESPIRATORY THERAPISTS:
Pulmonary Function Technologists and Respiratory Therapists perform home oxygen assessments, which are used for qualifying patients for home oxygen prescription and funding. Low oxygen levels may lead to light-headedness; oxygen prescriptions have an impact on falls prevention.
SOCIAL WORKERS AND SOCIAL SERVICE WORKERS:
Social workers in Mental Health can flag patients at risk for falls on their chart and ask about falls in their assessments. This information is then available on the electronic patient record for the full health care team to view. They can also take note of any symptoms or sensations that come up in sessions and ensure patients are not leaving feeling dissociated and disoriented.
In Family Practice setting: Social workers in Family Practice work in a multidisciplinary team so they may refer to their Family Practice Occupational Therapist or Physiotherapist for a further falls assessment. If during an assessment, it comes up that a patient is having difficulties getting groceries or doing their own self-care, and mobility issues might be part of the problem, then the social worker can refer this issue to the other team members. Some social workers can help to connect patients to resources such as Wheel Trans or Meals on Wheels if needed.
PHARMACISTS:
The pharmacy team works in clinics such as surgery, osteoporosis, and family practice. Pharmacists play an essential role in falls prevention through comprehensive medication assessments, with particular emphasis on identifying high-risk medications such as anti-anxiety drugs, tricyclic antidepressants or sleeping medications. These medications may cause side effects such as drowsiness, dizziness, hypotension, movement, or visual disturbances that increase the risk of falling. Through their identification, pharmacists can do risk-benefit analyses to suggest drug alternatives, discontinue or reduce medication dosing. Additionally, pharmacists can educate patients on medication safety and how to avoid unsafe drug interactions to decrease the risk of falling.
Polypharmacy (the act of taking multiple medications) can also put patients at a higher risk of experiencing falls. In collaboration with healthcare providers and patients, pharmacists can recommend deprescribing medications that are not essential or may be causing adverse effects. This can help reduce the number of medications a patient is taking and lower the risk of falls. By working with other healthcare providers, pharmacists can help reduce the incidence of falls among patients and improve their overall quality of life.