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QUESTION: Would other members be willing to comment on falls. Specifically, we would like to know what strategies and/or resources that other agencies use to prevent the individuals that they serve from falling and how they respond when falls occur. There is a lot of research with respect to falls relevant to older adults and best practices for prevention, but information specific to individuals with disabilities is difficult to find. Please share any best practices. Here are a few of the efforts we employ when addressing fall prevention: • Evaluate medications as possible causes and explore possibility of underlying conditions (ear infections, UTI, dizziness). • Ensuring there is appropriate lighting, especially at night and that we are using non-slip rugs, textured grips and grip bars in bathrooms. • Avoid using extension cords and ensuring areas are free of clutter. • Using appropriate adaptive equipment – walkers/wheelchairs, bed rails, Hoyer lifts, standers, etc. • Training persons served on using the appropriate adaptive equipment and documenting any refusal to use this equipment. • Ensuring staff are appropriately trained on how to do proper transfers and how to use any adaptive equipment. • Working with Regional Rehab on completing initial and ongoing evaluations for persons served with histories of falling and keeping fall management and risk plans updated with these recommendations. • Taping off emergency exit paths and have regular checks to ensure they remain free of clutter. • Nurses following up with various tracking (head injury tracking, etc.) to monitor a person after a fall. We always address falls within a High Risk Plan. Prevention steps are usually dependent on the individual and their needs such as if they utilize a walker, need staff assistance for ambulation, visual impairment, etc. When an individual does fall, staff will complete a head to toe check for injuries before getting them up off the floor. If an individual falls for no apparent reason such as tripping over a rug - vitals are taken as well. Prevention PT evaluations Clear path No rugs Bath mats in and out of shower Shower chairs Good fitting shoes (if severe fall risk may need to use shoes that have velcro) Stand by assist if needed per PT evaluation Gait belts with HRC approval and Doctor's orders Response Do NOT move client until assessment completed head to toe. Have client do active ROM if unable to do leave on ground and call 911 for assistance. Keep comfortable as possible. If verbal ask questions per assessment. If head injury suspected, start neuro checks per policy. On call list of all high fall risk clients due to diagnosis i.e.: Osteoporosis, history of knee, hip replacements or any old fractures these individuals may need to go to ER if staff state they cannot do ROM. The main thing we are working on doing is a better job of looking at the detail of all falls to determine what might have been contributors to it…medications, type of staff assistance given and needed, environment, activity, etc. We also track carefully the trend falls to determine if there are trends with the individuals, trends with the environment, activity, etc. I am sure these are things that are tried by others as well. We do a risk assessment and train staff on it, and the most effective method we have found is “stand by assist” when out of the home. We report falls “with” injury. This information is a compilation of suggestions, ideas, and opinions shared by INARF Members in response to the featured question. This information should not be considered official interpretation or guidance of State or Federal Policy. Additionally, statements within this document do not necessarily reflect an official position or opinion of INARF.