Falls Handbook – TOC
Deanna Gray Micelli DNSc, APRN, FAANP, Elizabeth Capezuti PhD, FAAN, William Lawson III, JD, and Patricia W. Iyer, MSN RN LNCC
Introduction
1 Overview of Falls in America
Deanna Gray-Miceli
A. National Imperatives
B. Defining Falls
1. Clinical perspective of patient falling
2. A case definition perspective
3. The researcher’s perspective
4. The falling person’s perspective
C. Geographic Distribution of Falls: Magnitude, Scope, Economic Impact and Incidence of Falls
1. Overview of data sources
2. Fatal fall incidences (children and older adults)
3. Non-fatal fall incidences (children and older adults)
4. Fatal fall incidence in the workplace
5. Economic impact of falls
6. Overview of Incidence of falls in medical care settings
a. Falls in the nursing home
b. Falls in children’s hospitals
c. Falls in the acute-care hospital
D. Consequences of Falls
1. Overview of common injuries
2. Hip fracture
3. Traumatic brain injury
4. Psychological injury
E. Patterns of Falls and Their Significance
G. Factors Associated with Falls
2. The Multifactorial Nature of Falls
Deanna Gray-Miceli
A. Factors Associated with Falls
B. Indoor and Outdoor Public Environmental Hazards and Falls
C. Environmental Hazards in and Around the Home and Their Assessment
1. Falls associated with steps
2. Falls in the bathroom
3. Other hazardous areas
D. Environmental Falls in Healthcare Settings
E. Equipment Safety
F. Medications Related to Falls
G. Age-Related Changes Associated with Falling
H. Medical Causes to Fall
I. Risk Factors Associated with Falls for an Older Adult (Intrinsic)
J. Risk Factor Assessment in the Medical Care Setting
3. Prevention of Falls in the Medical Care Setting
Deanna Gray-Miceli and Elizabeth Capezuti
A. General Issues Influencing Patient Safety and Quality Care
B. Levels of Prevention
C. Framework for reducing patient falls (adverse events): root cause analysis
1. Defining error
2. Process and components of root cause analysis
D. Measures to Prevent Patient Falls
1. Communication
2. Documentation
3. Environmental and equipment safety
4. Fall risk assessment
E. Fall Risk Assessment Versus Post Fall Assessment
1. Post fall assessment
2. Post fall treatment
F. General Issues to Consider Regarding Patient Falling
1. Autonomy
2. Medical stability
G. Institutional Policies and Procedures for Fall Reduction
H. Prevention of Falls in the Institutionalized Patient
1. Prevention of falls in the hospitalized elderly
2. Prevention of falls in hospitalized children
4 Prevention of Falls in Nursing Homes
Elizabeth Capezuti
A. Federal Regulations
B. Fall Risk Assessment in the Nursing Home
1. The process and use of fall risk assessment tools
2. Risk factors
C. Addressing Side Effects of Medications
D. Providing Appropriate Observation
E. Promoting Safe Mobility
F. Promoting Safe Transferring
G. Promoting Comfortable, Individualized Seating
H. Preventing Falls from Bed
5 Physical Restraints and Side Rails in the Elderly
Elizabeth Capezuti
A. Introduction
B. Definition
C. Restraint/Side-Rail Related Injuries, Including Death
D. Recent Research/Clinical Practice Regarding the Relationship to Falls/Injuries
E. Standards Related to use of Restraints
6. Legal Aspects of Falls
Elizabeth Capezuti, William Lawson and Patricia Iyer
A. The Legal Process
1. Damages/injuries
2. Caller’s relationship to patient
3. Caller’s perceptions of what was done wrong
4. Admissions and apologies
5. Location of the fall
6. Date of the fall
B. Standard of Care as a Dynamic Concept
C. Professional Policies and Guidelines
D. Common Allegations in Fall Cases
E. Evolution of the Suit
F. Defense Theories
1. Factual denial
2. Patient care or injury was the responsibility of others
3. Recognized complications
4. Standard of care was followed
5. Nursing judgment
6. Two schools of thought
7. Lack of proximate cause
8. Contributory negligence of plaintiff
9. Failure of plaintiff’s expert to list a deviation from nursing practice
G. Punitive Damages
1. Pattern of substandard care
2. Motivation to provide substandard care
3. Profits
4. Defense of punitive damages claims
Appendix
Case One: Inaccurate Description of Fall
Case Two: Dropped by Aides
Case Three: Fall Down Stairs
Case Four: Fall in Bathroom