CAPTURE

Collaboration and Proactive Teamwork Used to

Reduce

Falls

BestPracticesinSafeTransfersand
MobilitytoDecreaseFallRisk
August20,201310a.m.CST

DawnM.Venema,PT,PhD
JillHassel,DPT
KatherineJ.Jones,PT,PhD

Acknowledgement

Thisprojectissupportedbygrantnumber
R18HS021429fromtheAgencyforHealthcare
ResearchandQuality.Thecontentissolelythe
responsibilityoftheauthorsanddoesnot
necessarilyrepresenttheofficialviewsofthe
AgencyforHealthcareResearchandQuality.

LearningObjectives

DescribecurrentCAPTUREFallseventreport
statisticsregardingtypesandeffectsoffalls

Discusshowprinciplesofbalancerelatetofalls

Explainstrategiestoreducepatientfallrisk
duringassistedtransfersandambulation

Explainstrategiestoimprovepatientstabilityin
sitting

Part1:Introduction

Introduction

Introduction
Total Reported Falls in CAPTURE Falls
through July 2013 = 154
Assisted
24%
(N = 37)
Unassisted
76%
(N = 117)

Harm
32%
(N = 49)
No Harm
68%
(N = 105)

Introduction
Relationship Between Harm and Assistance
Assisted Falls
N = 37

Unassisted Falls
N = 117

Harm
19%
(N = 7)
No Harm
81%
(N = 30)

No Harm
64%
(N = 75)

Harm
36%
(N = 42)

Introduction
Five of the 49 harmful falls resulted in
moderate* or severe** harm.
ALL five of these falls were unassisted.
*moderate harm = Bodily or
psychological injury adversely affecting
functional ability or quality of life, but not
at the level of severe harm
**severe harm = Bodily or psychological
injury (including pain or disfigurement)
that interferes significantly with
functional ability or quality of life

Part2:BasicsPrinciplesofBalance
BasicPrinciplesofBalance*
*alsoknownasPosturalControl

BasicsPrinciplesofBalance
BaseofSupport(BOS)
Theareaonwhichthebodyrests;
Theareathatprovidessupportforthebody
LargerBOS=MoreStability

NarrowBase
OfSupport

WideBaseOf
Support
Photo Credit: myisoslim.com

BasicsPrinciplesofBalance
CenterofMass(COM)*

*alsoknownascenterofgravity(COG)
Thepointatwhichthemassofthebodyiscentered

Inanerectstandingposture,theCOMislocatedat
thesacrum

COMpositionmoveswithchangesinbodyposition

Photo Credit: www.acefitness.org

BasicsPrinciplesofBalance
Limits of Stability (LOS)
Themaximumdistancean
individualisableorwilling
tomovetheircenterofmass
inanydirectionwithoutloss
ofbalanceorchangingthe
baseofsupport
PhotoCredit:www.mygroupfit.com

BasicsPrinciplesofBalance
Balance
Balanceistheconditioninwhichalltheforcesacting
onthebodyarebalancedinsuchawaythatthecenter
ofmass(COM)stayswithinthelimitsofstability(LOS),
whichisdependentuponthebaseofsupport(BOS)

PhotoCredit:www.ycgf.org

BasicsPrinciplesofBalance
BalanceSimplified
HowDoWeMaintainourCenterofMass
withinourLimitsofStability?

Sensory
Input

Motor
Output

BasicsPrinciplesofBalance

PhotoCredit:
www.resourcesonbalance.com

Part3:SafeTransferandMobilityTechniques

SafeTransferandMobility
Techniques
Disclaimer:Thetransfertechniques
shownmayneedtobemodifiedfor
specificpatientdiagnoses

BodyMechanics

BasicBodyMechanicsPrinciples:
Thesaferyouare,thesaferyourpatientwillbe.
Adjusttheheightof
thebedasneeded

Useawidebaseof
support

Maintainthenatural
curvesofyourback
Bendatyourhips
andkneesinstead

Getyourcenterof
massclosetoyour
patientscenterof
mass

BodyMechanics

BasicBodyMechanicsPrinciples:
Thesaferyouare,thesaferyourpatientwillbe.
Moveorpivot
yourfeettoturn;
donottwistat
yourback

Alwaysletyour
patientassistas
muchaspossible

Performtransferin
asmoothmotion

Ifmorethan1
personisassisting,
communicate

LevelofAssistance
PTDocumentation:LevelofAssistance

Dependent: Patientrequirestotalassistance

MaxAssist:Patientdoes25%,Caregiverdoes75%

ModAssist:Patientdoes50%,Caregiverdoes50%

MinAssist:Patientdoes75%,Caregiverdoes25%

PhotoCredit:krames.sjmctx.com

LevelofAssistance
PTDocumentation:LevelofAssistance

ContactGuardAssist(CGA):Caregiverhashandsonpt justin
case,givesverbalcuesbutdoesnotphysicallyassist

StandByAssist(SBA):Caregiverisnearbyandreadytoassist
butdoesnottouchtheptMaygiveverbalcues

ModifiedIndependent:Pt isabletocompletethetransfer
withoutacaregiverpresentbutrequiresadaptiveequipment
tocompletethetask

Independent:Pt isabletocompletedthetransferwithouta
caregiverpresentandwithouttheuseofadaptiveequipment

University of Nebraska Medical Center

VideoMenuforToday
SupinetoSit
GaitBeltApplication
StandPivotTransferBedtoChairWithoutAssistiveDevice(1Assist)
StandPivotTransferChairtoBedWithAssistiveDevice(1Assist)
WheelchairManagement
SquatPivotTransferBedto/fromChair(2Assist)
AssistedAmbulation
Ambulation:ControllingaLossofBalance
AssistedFalltoaChair
AssistedFalltoFloor

SupineToSitTransfer:1PersonAssist

Video

SupineToSitTransfer:Safety
Iftwoassistisneeded,onecanhandlelegs,theother
canhandletrunk
Gathernecessaryequipmentprior tosittingup(gaitbelt,
nonslipsocks,walker,etc.)
Lowerbedoncept issittingsothatpts feetcontactfloor
Keep1handonthept onceinsitting
Watchforpotentialdizziness,orthostatic
hypotension(TakeorthostaticBPsifneeded)
Alsomaintainpt modestywithproperdraping

GaitBeltApplication

Video

GaitBeltApplication
GaitBeltHelpfulHints

Purposeistocontrolpatientscenterofmassduring
mobility,controldescentifafalloccurs,andreduce
chanceofgrabbingpatient'supperextremities

Placethebeltlowandsnug

Threadtheendthroughbothsidesofthebuckle
teethsidefirst.

Mayneedtoadjusttightnessonceinstanding

Holdfrombottomedgeofthebelt

GaitBeltApplication
GaitBeltHelpfulHints
Agoodwaytoensureagaitbeltisusedwithevery
transferistohaveitinaspecificplaceineveryroomso
itiseasytofind

Thesegaitbeltsarereadyforuse!!

BedToChairTransfer:1PersonAssist

Video

ChairToBedTransfer:WithDevice

Video

BedChairTransfer:Safety
Minimizedistancebetweenchairandbed
Patientshouldwearnonslipsocksorshoes
Useagaitbelt
Patientshouldinitiatestandwithwidebaseof
support,feetunderneaththeircenterofmass
Transfertowardsthepatientsstrongerside
Patientshouldmakecontactwithsurfacebefore
sitting

BedChairTransfer:W/C Management

Video

W/CManagement:Safety
Lockthebrakes
Swingaway/removeleg
reststopositionchairin
closeproximitytosurface
pt istransferringto/from
Iflegrestscantbe
removed,elevatethe
footplatesforthetransfer
Removearmrestifneeded

BedToChairTransfer:2PersonAssist

Video

ChairToBedTransfer:2PersonAssist

Video

BedChairTransfer:2PersonAssist
Techniqueshownisasquatpivot
Onecaregiverinfront,onebehindallowsforcloser
proximityofchair
Bestdoneintoawheelchairorchairwherearmrest
canberemoved
Caregiverinfrontshiftshis/herbodyweightbackward
aspt leansforward,whichelevatesthepts hips
Caregiverbehindhelpssteerpelvis

CorrectChairPositioning

PhotoCredit:http://mediacache
ak1.pinimg.com/originals/60/02/b0/600
2b026e8fae7fe37e78156db05faee.jpg

CorrectChairPositioning

PosteriorPelvicTiltVs.AnteriorPelvicTilt
PhotoCredit:www.longevityforyou.com

ChairFitConsiderations
Seatheight:Canpatientsfeettouchthefloor?
Seatdepth:Howdoesthiscomparetopatient
height/femurlength?Canpatientsfeettouchthe
floor?Whatisthepositionofthepatientspelvis
(anteriorvs.posteriortilt)?
Seatwidth:Ispatientslumpingtooneside?
Elevatinglegs:Maybeindicatedmedicallyorfor
comfort.Mayalsoposeafallhazard.

ChairCharacteristics
Chairwithpoor
characteristics

Chairwithgood
characteristics

Chair with Good Characteristics

Elevating arm rest

facilitates transfers
from bed to chair

AssistedAmbulation

Video

Ambulation:ControllingaLossofBalance

Video

Ambulation:AssistedFalltoaChair

Video

Ambulation:AssistedFalltotheFloor

Video

AmbulationandAssistedFalls:Safety
Guardonweakerside(ifthereisasymmetry
ofstrength)
Maintainawidebaseofsupportyourself
Usethegaitbelttocontrolmovementof
patientscenterofmassintheeventofafall
Usethegaitbelttodirectthepts centerofmass
backovertheirbaseofsupport
Pullpatienttowardsyouoranotherstableobject,
and/orretarddescent

Summary
InfallsreportedbyCAPTUREFallshospitals,there
wasasmallerpercentageofharmfulfallswhenthe
fallswereassistedvs.unassisted.
Balance=maintainingonescenterofmasswithin
oneslimitsofstabilityand/orbaseofsupport.It
requiressensoryinputandmotoroutput.
Useproperbodymechanicswhenassistingpatients
withtransfersandgait.Ifyouarestable,youcan
helpyourpatientstaystable.
Ifindoubt,askforhelp!

Acknowledgements:Videos

Stephen Smith: Instructional

Technologist/Videographer, College of Nursing, UNMC

Winifred Finegan: Standardized Patient, UNMC

Zach Douglas, Physical Therapy Student, UNMC

PhotoCredit:www.teambuildingtechniques.com

ThankYou

References/Resources
FairchildS.PiersonandFairchildsPrinciplesand
TechniquesofPatientCare.St.Louis,MO:Elsevier
Saunders;2013.
OSullivanSB,SchmitzTJ.PhysicalRehabilitation.5th ed.
Philadelphia,PA:F.A.DavisCompany;2007.
U.S.DepartmentofVeteransAffairs includes
informationonpatientcareergonomics,algorithmsfor
safepatienthandling,bariatrictoolkit,andmore:
http://www.visn8.va.gov/patientsafetycenter/safePtHan
dling/

ContactInformation

DawnVenema,PT,PhD
dvenema@unmc.edu

UniversityofNebraskaMedicalCenter

Pleasecompletethewebinar
evaluationbyclickingonthelink
below:
https://www.research.net/s/capturefalls-eval8

We value your input!

UniversityofNebraskaMedicalCenter
University of Nebraska Medical Center

CAPTURE
Collaboration and Proactive Teamwork Used to Reduce

Falls

http://unmc.edu/patient-safety/capture_falls.htm