MDS Alert
Don't Let Rehab Progress Translate Into Accidents
Are therapy minutes in Section P adding up to falls, fractures in Section J?
The problem: A resident who is progressing in physical therapy may believe she is stronger and doesn't need help from staff, which increases her risk for falls, cautions Nemcy Cavite Duran, RN, BSN, CRNAC, director of MDS for Dr. William O. Benenson Rehabilitation Pavilion in Flushing, NY.
Solution: The interdisciplinary team should develop an individualized care plan to address the issue, she says.
If the resident is cognitively intact enough to counsel, talk to him about the issue, and come up with a plan to help him "show his stuff" but also prevent falls/injuries, advises Diana Waugh, RN, principal of Waugh Consulting in Waterville, OH. For example, ask him to request supervision when he does activities where he still feels uncertain or has fallen before when doing them. And give him "opportunities to show independence and ability in ways that will not extensively jeopardize his safety."
When providing rehab to people with cognitive impairment, preempt falls by getting to know who the person is before she starts therapy, advises Waugh.
For example, if the family tells you the resident is willful and has always enjoyed being independent, you can bet the person will get up without asking for help once she is able to do so, Waugh cautions.
Four strategies can help prevent falls and related injuries in that type of scenario, Waugh suggests:
• Alter the environment to remove fall hazards.
• Have staff engage the person in walking every chance they get.
• Involve the resident in an activity when she is sitting down, "whether it's clipping coupons or whatever interests her and mirrors her life interests." A person who has an activity in her lap is more likely to try to hand it off to someone as a cue she's ready to get up or needs something, Waugh points out.
• Assign volunteers to work with the person on an activity.
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