Rehabilitation outcomes are compromised of acquired adverse conditions, including falls. Falls and resulting injury affect a person’s function, independence, and quality of life. These are complicated by age-related changes associated with decreased strength, endurance, reserve, frailty, social, and financial resources. Multidisciplinary teams are essential for effective fall and injury prevention across healthcare settings. By completing this certificate, you will gain vital knowledge in 1) clinical assessment with a specific focus on core fall risk factors associated with mobility and toileting, 2) patient education and engagement, emphasizing teach back techniques, 3) post fall management, with guided instruction in post fall huddles, and 4) program evaluation to increase precision and outcome management.
Every rehabilitation professional appreciates the complexity of maximizing function, independence, autonomy, and safety for persons living with disability, chronic disease, and varied cognitive status. This certificate is intended for nurses.
7 hours of online video lectures and patient demonstrations.
Case-based quizzes to evaluate and improve clinical reasoning.
Recorded Q&A sessions between instructors and practice managers.
Within healthcare organizations, fall risk determination is underestimated because of an over-reliance on the use of fall risk screening tools that generate a score and then universal fall precautions. This chapter builds upon best practice to engage rehabilitation nurses in multifactorial fall and injury risk assessment as the basis for individualized fall and injury prevention plans of care.
National guidelines serve as the foundation to reaffirm rehabilitation nurses’ vital role in using clinical assessment and decision-making skills to determine fall and injury risk factors and integrate findings into interdisciplinary care planning. Select fall risk factors will be featured during this session as examples of the importance of developing nurses’ clinical knowledge and skills.
The examination of clinical practice skills generates opportunities to verify accuracy and competency of care. Often, variations in practice are found that should not occur, or risk factors are omitted from current assessment that deserve priority inclusion in the fall and injury risk assessment policies. This session offers rehabilitation nurses live demonstration of clinical assessment of the fall and injury risk factors in practice: history taking, physical exam, risk factor determination, individualized interdisciplinary care referral, and planning.
Much emphasis exists today on strategies to engage patients as full partners in their healthcare. One of those strategies is through rehabilitation nurses’ direct interaction with and education of patients and families. Education is more than one-way communication, handing a patient an education brochure, and/or discharge planning. This session shapes rehabilitation nurses’ approach to patient and family education by focusing on teachable domains of learning.
Rehabilitation nurses engage in formal and informal patient and family education opportunities. However, the majority of such engagement remains informal, without two-way communication methods to evaluate effectiveness of teaching or learning. Health literacy tools enable the redesign of patient education approaches to maximize patient learning.
Systems theory provides the theoretical approach that reinforces education is not a one-way process, rather an open system of communication between a sender and a receiver. Engaging patient education as an open system approach requires that rehabilitation nurses as educators remain mindful of the environmental and interaction factors that facilitate or impede exchange of information and successful learning. Tools to evaluate successful learning will be presented so rehabilitation nurses can measure education outcomes.
Falls associated with toileting refer to the activities specific to navigating the physical environment to use the toilet, the physical act of elimination, the environment design of the bathroom, and staffing assistance. These activities are complex and interactive. This chapter introduces an organizational framework that aligns each activity as a contributing fall risk factor that will then be categorized to a specific type of fall.
Universal approaches to patient toileting programs fail to address the unique toileting needs of each patient. Clinical practice standards require that rehabilitation nurses use clinical judgment to determine each patient’s specific toileting needs and schedule. Rehabilitation nurses will utilize their clinical expertise to maximize each patient’s functional ability to toilet and increase functional independence.
Safe toileting mobility requires that rehabilitation nurses have the physical assessment skills to evaluate a patient’s ability to manage toileting. These physical assessment skills involve patient handling (i.e., transfers, ambulation, toileting) and activities of daily living tasks (i.e., clothing management, personal hygiene toileting, grooming) that must be assessed for individualized care planning. The rehabilitation nurse must consider each patient’s functional level of dependence/independence (independent, assisted, dependent), weight-bearing status, need for caregiver assistance, and additional fall risk factors (orthostasis, centrally acting medications, diuretics). Rehabilitation nurses will have the opportunity to refresh physical mobility assessment skills into practice as a means to individualize patient care approach and engage the patient/caregiver as a partner in care.
When a patient fall occurs, staff members make every effort to immediately respond. They assess the patient’s status upon rescue, uncover the circumstances of the fall, and then decide on appropriate care management. A group of providers struggle to ascertain the immediate or root cause of the fall. Acknowledging that 80% to 90% of falls that happen in hospitals are unwitnessed (Oliver, et al., 2010), patient involvement in the post-fall huddle is essential. This chapter dramatizes the conduct of an actual post fall huddle following a patient fall.
A fall event generates an organizational response to investigate and understand all the contributing circumstances of the fall. This organizational response is observable through various communication systems: huddles, post-fall assessment, incident reports, and hand-off communication. In this chapter, rehabilitation nurses will distinguish the value of each component of post-fall management and the unique purpose of the post-fall huddle as the first action from all other huddles, outline the eight steps of the post-fall huddle process, utilize accident theory to visualize the complexity of immediate/root cause determination.
Program evaluation is a detailed and comprehensive process that includes formative and summative components. Fall rates, as an outcome, are insufficient to examine the effectiveness of fall prevention. Rather, the post-fall huddle should be examined as a program intervention that, when implemented provides increased depth and breadth to understanding patient falls. During this chapter, rehabilitation nurses will learn a detailed program evaluation model applied to post-fall huddle to determine efficiency and effectiveness.
All rehabilitation nurses want to evaluate the outcomes of their fall prevention practices. These outcomes are dependent on each patient’s risk factors, each unit’s context, and overall organizational characteristics. Rehabilitation nurses experience these complexities 24 hours a day, and therefore are vital to the preparation phase to plan for and initiate an evaluation. During this session, rehabilitation nurses will learn basic components of program evaluation and apply these components to fall and fall injury prevention programs, creating a more precise road map at the patient, unit, and organizational level.
Understanding changes in outcomes requires that structures and processes be clearly defined, linked, and trended to the correct outcome. Structures and processes must be measured twice as much as outcomes in order to discover, in real time, barriers and facilitators to program improvement. Simply monitoring a fall rate or counting number of days between falls is insufficient to determine fall program effectiveness. In this session, rehabilitation nurses will define and contrast three types of falls and align specific actions to reduce each type of fall, deconstruct structures and processes to reduce serious injuries, and assess baseline program status in order to initiate prioritized actions.
High-reliability organizations (HROs) commit to a culture of safety and transparency through continuous systems of improvement. These systems rely on valid, reliable, and continuous measurement to track implementation and then evaluation. During this chapter, rehabilitation nurses will utilize post-fall huddle data analysis and organizational self-assessment as two tools to evaluate fall and fall injury programs.
High-reliability organizations (HROs) and organizations of excellence strive to showcase how their organizations compare and outperform like units and organizations. HROs commit to a culture of safety and transparency through continuous systems of improvement. Program evaluation invites inquiry into the uniqueness of each culture, and this inquiry can excite new methods of program evaluation. In this chapter, rehabilitation nurses will be introduced to innovative methods of program evaluation to be considered within their unit and organization.
Amy Lee, MPT, OCS
Physical Therapy Central
Zach Steele, PT, DPT, OCS
Outpatient Physical Therapy & Rehabilitation Services
Grant R. Koster, PT, ATC, FACHE
Vice President of Clinical Operations, Athletico Physical Therapy