Should Caregivers Attempt to Assist Falling Patients?

Abstract

This quality improvement project seeks to provide guidance on whether caregivers should attempt to “assist” fallers, and if so, the safest way to minimize injury to themselves and the faller. Primary aims were to: 1) Identify common characteristics of documented assisted falls, 2) Identify cases where injuries to patients and/or staff occur, and 3) Provide guidance to the clinical field. Data sources for this project includes secondary databases of assisted falls events as well as primary data collection using computer simulation. Initial results for 2 VA quality tracking databases of assisted falls over a 9-year period are presented. Qualitative matrix analyses were conducted for both assisted falls datasets, which separately examined patient and employee injuries related to assisted falls. Two trained qualitative experts analyzed 195 fall narratives from the datasets to develop insights about the most common fall scenarios that result in injury. The most commonly reported assisted falls scenarios included 1) related to toileting, 2) while ambulating, and 3) while transferring from wheelchair. Findings of these analyses indicate current documentation does not capture the nuance of assisted falls. Additional variables such as 1) the direction of the fall; 2) the fall scenario; 3) how staff sought to assist; 4) staff injury description and 5) and other key variables (patient symptoms, environmental factors) that could improve fall documentation and understanding of assisted falls. Preliminary efforts are providing information for development of a computer simulation using a virtual environment to repeatedly test common fall scenarios and influences of caregiver assistance.

Staff Low Back Injury Risk During Assisted Falls Virtual Reality Simulations

“…Dynamic factors like shear, tension, and torsion were not studied given that all trials exceeded the safety threshold of 3,400 N and adding these factors would have likely further increased the spinal compression forces (Tözeren, 2006; Zhang et al, 2020). This project focused only on staff low back injury in a small sample size and did not address other less common injury sites which may occur during assisted falls like the knees, shoulders, and neck (Bulat et al, 2020).…”

“…The Assisted Falls in VHA project was determined to be quality improvement (QI) by the James A. Haley Veterans’ Hospital Research and Development Committee. VR simulations of common assisted falls scenarios were used to calculate spinal compression forces to correlate to staff low back injury risk (Bulat et al, 2020; Gasteiger et al, 2022).…”

“…The VR simulations of a computer-generated bathroom environment were designed for the Steam platform with Unity, Autodesk Maya, and Adobe software at the University of South Florida Advanced Visualization Center lab. Simulations were developed based on the three most common assisted falls scenarios identified by our qualitative review of VHA patient safety narratives: fall upon standing from toilet, fall upon sitting down on wheelchair, and fall upon ambulation (Bulat et al, 2020). A male patient avatar was programmed to simulate the three most common independent transfer scenarios from toilet to wheelchair in the VR bathroom but did not have communication capabilities.…”

Development of a behavioural framework for dementia care partners’ fall risk management

“…Other studies also found that care partners provided immediate assistance when OLWD fell, despite no prior training to do so without causing injuries to OLWD or themselves [ 64 ]. The lack of training for care partners might cause injuries among family care partners, which received little attention [ 65 ].…”