Falls prevention

There are 2 assessments related to falls prevention: Stratify falls risk assessment
and Cannard risk assessment.
Stratify falls risk assessment underlines 3 main topics which lead at the final
score. There is a question regarding the transfer score, one regarding mobility
and 5 questions related to the history in the last 6 months, the state of the
resident (agitated or not), any visual impairment, the frequency of toileting, and
transfer+mobility score. If the score is >2, there is a high risk of falling.
Cannard risk assessment refers to subjects that include the age, sex, walking
ability, sensory deficit, falls history, medication, medical history, mobility. There
are 3 categories of risks: low risk, medium and high.

Marie Brennan has history of falls. Her Cannard Score is 13 (female, <70,
unsteady, balance deficit, in ward fall history, medication for hypotension,
history of disease/confusion, mobility-requires assistance).
Regarding Stratify Score, Ive noticed a contradiction, Marie Brennan having a
low risk of falls. She needs frequent toileting and therefore this point changes
the score in high risk.

Preventive measures in place:

- Since Marie has MS, and she tends to pick-up things from the floor and
fix her shoes while she is in wheelchair, she is being explained that this
behavior can cause her harm and she should ask for assistance when she
need it.
- Every 4 months, Stratify and Cannard fall risk assessment is reviewed.
- All hazards from Marie room and corridor are removed.
- The lights are checked for proper working in the room, bathroom and
surroundings.
- Bed rails checked while Marie is in bed. Bed rails are checked to be up
and correctly fitted. 2h safety is completed.
- Bed is kept at the lowest level.
- Staff is aware to check and report any sign of wear, tear, rusting, flaking
or loosening of the rail to the Person in Charge.
- While she is in wheelchair, Marie uses the seat belt. Chair alarm is
checked to be always in place.
- Marie is using a call bell whenever she need it.
- HSE bed rail assessment is done. Marie is on air mattress calibrated to her
weight, which can move her involuntarily. The bed rail risk assessment
shows medium risk for using it, but Clinical judgment considers that
using bed rails is safer than not using them.
 - Marie is monitored while she is using the toilet as she tends to move
herself.
- Marie uses hip protectors to prevent an eventual fracture of the hip caused
by the fall.
- Marie wears correct and adequate footwear.

After reviewing the assessments, care plans and the videos, Ive noticed that
there are some preventive measures which can be applied:
- tips to avoid falls, leaflet to patient and family;
- sticker over bed to identify fall risk;
- the specification in the care plan that Marie goes to physiotherapy, and the
role of physiotherapy in assessing and improving gait and balance;
- the specification of checking orthostatic BP first thing in the morning. The
proper way to check BP is by laying down the resident for 5 minutes, then
immediately after standing, BP and pulse are taken again. After 2 minutes,
BP and pulse check is repeated;
- Specification about hand rails, which should be in place on both sides and
well secured when Marie is using the toilet;
- Mention about the floors, that should be dry, without spillages;
- Items stored safely within reach;
- Mention about clothing which should be well fitting. Trousers, skirts and
nightwear should not be longer than sitting just below the ankles;
- Mention about the importance of a well balanced diet to keep muscles and
bones strong.
- The specification of the staff training regarding the proper use of hoist.