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No False Steps Falls Prevention Program


Lillian Amador, Irina Fonaryuk, Kevin Lee
Pacific Lutheran University

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ASSESSMENT
Falls are a significant public health issue as demonstrated by their impact on society in terms of individual health outcomes and systemic costs. From 1997-2007 falls were the leading cause of injuries.
Annual Rate* of Injury Episodes for Leading Causes of Injury, by Sex National Health Interview Survey, United States, 2004--2007

ANALYSIS Nursing Diagnosis


Risk for falls among relatives raising children in Pierce County related to lack of easily accessible resources such as educational materials, interactive programs, and promotion of fall prevention among the target population, as evidenced by statistical data and key informant interviews. Systems Theory
Systems Theory of No False Steps Falls Prevention Program

PLANNING
The No False Steps falls prevention program will decrease incidence of falls among Kinship Caregiver population by providing risk assessments and education on behavioral, medication and environmental risk factors, as well as providing referrals to community fall prevention resources such as exercise programs (i.e. Stay Active and Independent for Life).
Core Function: Assurance
Through needs assessment, research, resource development, and formation of community partnerships we are assuring that our clients will have knowledge and access to prevent falls.

IMPLEMENTATION
Research existing data pertaining to incidence and health implications of falls at national, state, and local level. (completed) Develop and implement survey to identify needs and preferences of our unique population regarding falls prevention. (completed) Gather evidence based data on effective tools for fall prevention and select those appropriate for our unique population through collaboration with Rosalyn Alber, Kay Coulter, and Kathy Moisio. (completed) Research and identify existing fall prevention resources in community such as Fall Prevention Coalition of Pierce County and SAILs exercise programs available in Pierce County. (completed) Develop fall prevention pamphlet template and provide to HopeSparks to facilitate distribution to client population. (completed) Suggest fall assessment tool and protocols for inclusion in the HopeSparks geriatric questionnaire to better assist student nurses in identifying clients at risk and providing appropriate interventions. (ongoing) Identify potential community partners and establish community action groups. (ongoing)

Pierce
INPUT
Primary Care Providers Washington State Department of Health Aging and Long Term Care Aging and Disability Resource Center Pierce County Coalition Tacoma Department of Health Center for Disease Control and Prevention Local Hospitals PLU Nursing Students Clients at risk for falls Institution of Higher Learning PT, OT, Home Health Nurse

HopeSparks
Clients in the Kinship Care Program

County
OUTPUT
Referrals to Specialist Third Party Payers Public Assistance Community Centers Stay Active & Independent for Life Community Improvements PT, OT, Home Health Care Nursing Student Home Safety Modifications Cost Savings Decrease Morbidity Behavior Modifications Community Partnership

Level of Prevention: Primary and Secondary


Our project will serve primary prevention needs by screening target population for clients who are at risk for falls. Our project will serve secondary prevention by reducing the incidence of falls among those identify as being at risk.

THROUGHPUT
Falls Prevention Program Risk Assessment Health Assessment Education Environmental Assessment Community Outreach

(CDC, 2009)

GOALS and OBJECTIVES


Short Term Goals:
1.Assess the need for falls prevention programs within our target population. Objectives: (each to be completed by April 30, 2010) a) Assess fall risks for target population. b) Assess falls prevention resources already available in the community. 2.Choose a fall assessment tool for inclusion in geriatric survey. Objectives: (each to be completed by April 30, 2010) a) Research efficacy of existing tools . b) Identify unique characteristics of our target population.

More than 19.2 billion dollars was spent for treating fall related injuries in 2000. Washington States death rates due to falls significantly exceed the national average with 10.2 per 100,000 deaths due to falls in WA state in 2006.

FEEDBACK

HEALTHY PEOPLE 2010


The US Department of Health and Human Services has Identified two overarching goals for improving the health of the US population . As published in Healthy People 2010 these are:
Goal 1: Increase quality and years of healthy life. The first goal of Healthy People 2010 is to help individuals of all ages to increase life expectancy and improve their quality of life. Goal 2: Eliminate health disparities. The second goal of Healthy People 2010 is to help our nation eliminate health disparities among different segments of our population.

EVALUATION
Short Term Goals 1. Met through development of client survey. Ongoing in terms of administration to clients. 2. Met through evidence based research. Intermediate Goal 1. Met through research, analysis and synthesizing data into consumer friendly format. Long Term Goals 1. Not Met. (pending program implementation) 2. Not Met. (pending program implementation)

Intermediate Goals

(WA DOH, 2007)

In 2005, falls resulted in 12,200 hospitalizations and nearly 500 deaths among older adults 65+. In Pierce County, for the years 2003-2007, had a non-fatal unintentional fall rate of 1771 per 100,000 residents ages 45-85+ compared to a state wide average rate for the same population and period of 1252 per 100,000.

1. Develop a consumer friendly educational and resource brochure on falls prevention. Objectives: (each to be completed by May 19, 2010) a) Determine appropriate content for brochure. b) Finalize master template for brochure.

The No False Steps fall prevention program will address these goals by addressing several associated focus areas, including
FA1: FA2: FA6: FA7: FA11: Access to Quality Health Services Arthritis, Osteoporosis, Chronic Back Conditions Disability and Secondary Conditions Educational Community Based Programs Health Communication

Long Term Goals:


1.Decrease the number of preventable falls in the community. Objectives: a) All clients identified as being at risk for falls will enter a fall prevention contract within six months of No False Steps program implementation. b) At risk clients will develop a personal fall prevention plan that addresses exercise needs, medication regimens, environmental hazards, and risk behaviors within one month of signing fall prevention contract. c) Clients will report an increased sense of physical safety when engaged in activity within one year of entering No False Steps program. 2.Formation of community action groups to address public fall hazards. Objectives: a) Identify potential community partners within six months of No False Steps program implementation. b) Assess public fall hazards. c) Recruit members for action groups.

Falls Risk Factors in Older Adults


History of Previous Falls Chronic Health Conditions Four or More Medications or any Psychoactive Medication Physical and Functional Impairment (gait, balance, strength) Vision Impairment Physical Environment (clutter, poor lighting, slippery surfaces) Behavioral Risk

REFERENCES
Centers for Disease Control and Prevention. (2010). Injury prevention and control: home and recreational safety. Retrieved March 30, 2010 from www.cdc.gov Center for Healthy Aging.(2007). Fall prevention. Retrieved March 30,2010 from http://www.healthyagingprograms.org/content.asp?sectionid=69 Fall Prevention.(2009). Fall prevention. Retrieved March 30,2010 from http://www.fallprevention.org/index.htm Office of the Governor. (2008). Falls among older adults- a serious public health problem in Washington State. Retrieved March 30, 2010 from http://www.governor.wa.gov/ltctf/reports/071707/older_adults.pdf Healthy People 2010. (2010). Injury and violence prevention. Retrieved February 18, 2010, from www.healthypeople.gov Pierce County Human Services. (2010). Stay active and independent for life. Retrieved March 30, 2010 from http://www.piercecountywa.org/pc/abtus/ourorg/humsvcs/altc/adrc/SAILclasses.htm Stanhope, J., & Lancaster, J. (2008). Public health nursing (7th ed.). St. Louis, MO: Mosby Elsevier. Washington State Department of Health. (2009). Injury and violence prevention program. Retrieved March 21, 2010 from http://www.doh.wa.gov/hsqa/emstrauma/injury/rate_analyzer/

FA15: Injury and Violence Prevention FA22: Physical Activity and Fitness FA28: Vision and Hearing with specific attention to Healthy People Objectives:

Key Informant Interview:


Among the Kinship Care population served in Pierce County it is estimated that 55-60 percent are at high risk for falls, yet currently no falls prevention program serves these individuals.

Objective15- 27: Reduce death from falls. Objective 15-28: Reduce hip fractures among older adults.

TEMPLATE DESIGN 2008

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