Appendix B11: Fall Interventions Plan

The Falls Management Program Manual

Text Description

Resident: ____________________________________________   Room: ___________________

Directions: Check all interventions that apply.

Risk Factor: MedicationsRisk Factor: Mobility

Selected Interventions

For changes in psychotropic meds:

__ Monitor and report changes in anxiety, sleep patterns, behavior, or mood
__ Monitor and report drug side effects
__ Behavior management strategies
   __ Sleep hygiene measures
   __ no caffeine after 4 p.m.
   __ up at night with supervision
   __ comfort measures
    __ pain management
   __ regular exercise, limit napping
   __ relaxing bed routine
   __ individualized toileting at night
   __ safe bathroom routine

For changes in digoxin:

__ Monitor apical heart rate; if <50, notify PCP.

Selected Interventions

__ Increase staff assistance
   __ early morning
   __ to and from toilet
   __ during all transfers
   __ during ambulation
   __ other: ________________________
__ Correct height of bed, toilet, or chair
   __ Keep bed at correct height as marked on footrest or wall
    __ Use raised toilet seat
   __ Use cushion in lounge chair
   __ Lower lounge chair
__ Increase bathroom safety
   __ Use adequate handrail support
   __ Use easy to manage clothing
__ Promote wheelchair safety
   __ Use individualized, labeled wheelchair
   __ Check brakes and instruct pt on use
__ Seating modifications
   __ Use all prescribed seating items
__ Other: _______________________________

Risk Factor: Orthostatic HypotensionRisk Factor: Unsafe Behavior
Selected Interventions
__ Low blood pressure precautions
   __ Instruct pt to change position slowly
   __ Instruct pt to sit on edge of bed and dangle feet before          standing
   __ Instruct pt to use dorsiflexion before standing
   __ Instruct pt not to tilt head backwards
   __ Provide staff assistance in early AM and after meals
__ If medication change:
   __ Take postural VS __ day X 3 days. If systolic drops ≥20 mm          Hg on day 3, notify PCP
__ Promote adequate hydration
__ TED hose
__ Other: _________________________________
Selected Interventions
__ Behavior management strategies
__ Increase assistance and surveillance
   __ Position or pressure change alarm
   __ Movement sensor
   __ Locate patient near station
   __ Intercom
   __ Toilet at regular intervals
   __ Increase activities involvement
   __ Other ___________________________
__ Reduce risk of injury
    __ Low bed
    __ Floor mat
   __ Helmet, wrist guards, hip protectors
   __ Nonslip mat
    __ Nonskid strips or nonskid rug
    __ Nonskid socks
   __ Lower or remove side rails
__ Increase comfort
   __ Pain management
   __ Frequent rest periods
   __ Recliner or chair with deep seat
   __ Rocking chair
   __ Wheelchair seating items
   __ Exercise
   __ Cradle mattress
   __ Sheepskin, air mattress or pillows
__ Other: _________________________________
Risk Factor: Vision
Selected Interventions
__ Low vision precautions
   __ Use maximum wattage allowed by fixture
   __ Increase lighting in room
   __ Use adequate lighting at night
   __ Add high-contrast strips on stairs, curbs, etc.
   __ Use signs with large letters or pictures
   __ Use high contrast to offset visual targets
   __ Reduce glare
__ Corrective lenses
   __ Keep eyewear within easy reach at all times
   __ Encourage patient to wear glasses
__ Other: _________________________________

Signature: __________________________________________________     Date: ______________

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Current as of February 2010
Internet Citation: Appendix B11: Fall Interventions Plan: The Falls Management Program Manual. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/fallspxmanapb6.html