Question

(Implement falls prevention strategies)

Case study  

Sally is preparing a falls prevention strategy for Angelo, who she supports in an aged care facility. Angelo is 86, and had two mini strokes that caused him to fall in the past. One fall caused Angelo a minor head injury, and he was momentarily concussed. Both times, Angelo was unable to get up on his own. Angelo is frightened of falling again, so avoids walking around unnecessarily.

Sally wants to encourage Angelo to live independently and safely. Sally uses the facility’s risk assessment forms to assess Angelo’s risk of falling, and has organised Angelo’s carer (his son, Michael) to also be present for the assessment process.

During assessment, Sally interviews Angelo about his feelings about previous falls. Angelo is embarrassed, and doesn’t want to talk about it. When Sally talks to Angelo’s son, Michael, about the falls, Michael says Angelo feels his integrity as a strong man has been weakened by the falls.

Sally in concerned because the falls mean that Angelo refuses to walk unless he really has to. He is not going outside for exercise, and avoids stairs or any uneven surfaces, which limits the activities he can do.

Sally is also concerned that Angelo smokes heavily. She does not know if this increases Angelo’s risk of stroke, but she is worried about his health in general. Angelo also has a poor diet. He doesn't’ eat many vegetables or diary, but eats a lot of sweet food, like pastries.

Sally organises a meeting with Angelo, Michael, two other workers and her supervisor to discuss and plan the falls prevention strategy for Angelo. The meeting runs for an hour. Sally brings Angelo’s medical history, his medication and blood pressure chart. She also brings a letter of recommendation from Angelo’s GP, which recommends that Angelo decrease his cigarette consumption as it increases the risk of stroke.

Sally and Angelo’s care team decide to use the following strategies to monitor the success of the falls prevention strategy:

• Interviewing Angelo formally every week and informally daily about strategies
• Reviewing incident reports
• Calling a weekly meeting with the team to discuss
• Reviewing Angelo’s falls diary every day

After one month, the following had occurred:

• Angelo nearly slipped and fell when using stairs to access a new physical activity on the lawn.
• Angelo nearly fell when tripping over a fallen branch in the garden.
• Angelo did not decrease his cigarette intake.
• Angelo did not regularly take vitamin D supplements.

1. Why should Sally share and celebrate any positive results with Angelo, Michael, other workers, her supervisor or health professionals as appropriate?
2. Identify when and why strategies are not having the desired result and any indicators of increased risk.
3. Determine future strategies and actions, including referral to other services.
4. Why should Sally consider when completing, maintaining and storing all relevant documentation and reports about Angelo?

Answer 1

The scenario describes about Mr.Angelo, 86 years old man, sroke patient with the habit of heavy smoking who had a history of fall twice & got head injury. The health care provider Saly encourages him to live independently & safely, because he refuses to walk unless he really has to.

She only worried about his health in general. She followed a fall prevention strategy after in dicussiodi with the care team of Angelo. During the meeting Saly brought his mefmedi history, BP & medication chart & also his GP's recommendations. The recommendation sheet GP written that Angelo decreased his cigarette consumption as it increases the risk of stroke. But in actual Angelo didn't make any changes in smoking pattern.

Importance of communication in health care settings

Barriers in this scenario is

1 ) Eventhough Sally knows very well about the fact that Angelo smokes heavily, but she did not aware that smoking will increase the chances of stroke. Since she gave no importance to this because of lack of knowledge she didn't escalated the fact & come with GP' reference that shows Angelo reduced smoking habits since it increases the risk of stroke.

2 ) He had a poor diet because he doesn't eat many vegetables or diaries, but he eats sweet foods such as pastries. Saly didn't arise this problem infront of the care team & she didn't educated the patient as well.

3 ) Fall prevention strategies

The team had followed fall prevention strategies effectively through interviews, diaries & monitoring, but without understanding & solving the main underlying issues the team can never prevent the incidence of fall among Angelo.

This why the strategies didn't got the desired effect.

Collaborative care for stroke patients

Primary prevention ( decrease morbidity & mortality )

Health promotion

Healthy diet ( reduce salt & sodium, Low in saturated fat, total fat & dietary cholesterol & high in fruits and vegetables (

Weight control

Regular exercise

No smoking

Limit alcohol consumption

Routine health assessment ( Diabetes, hypertension, cardiac dysfunction require close Management )

Patient should be evaluated by a Physiatrist ( a physician who specialised in physPhys medicine & rehabilitation. With the help of a physiotherapist the patient can undertake exercises & mobilization. Reference to a dietitian can surely improve the nutritional status by following the menu prescribed by them. Monitoring daily for the vital signs & the information should be documented clearly for further references & communicating with other health care providers.