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BPGs in Action

Falls Prevention

Tools & Resources
Context & Considerations
PPE
Virtual Care
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Tools & Resources

Falls Prevention Checklist

  • Assess client for history of falls, gait/balance & mobility issues.
  • Screen environment for factors that may contribute to falls such as wet surfaces, clutter (IV poles, debris, etc.) and poor lighting. Ensure bed rails are in their upright position.
  • Ensure that clients who use assistive devices have easy access to them.
  • Refer clients to allied health specialists such as occupational/physio-therapist when they require additional support.
  • Identify medications that cause increased drowsiness, visual or gait changes which may lead to increased falls risk.
  • Create a care plan in collaboration with person & family, including patient education and strategies to reduce falls risk including exercise/strength training as well as visual acuity exams.
  • Consider changes in cognition, which may alter the client's ability to recognize the necessity of increased supports or changes in physical capabilities.
  • Consider dietary changes that reduce the risk of bone fractures related to falls by optimizing bone health such as vitamin D enriched foods.
  • Encourage clients to take their time when moving and ambulating, doing only one task at a given time.
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Context & Considerations

Organizational Policies

Your healthcare organization may have policies and procedures around falls prevention — be sure to review these documents for any recommendations specific to your place of work.

Person-centred Care

Collaborating with clients can go a long way in reducing the occurrence of falls. If you haven’t already, review the Person- & Family-Centred Care point-of-care page for strategies on improving collaboration and communication with clients.
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PPE

Falls & PPE

PPE can reduce visibility and make mobility challenges worse. To reduce the impact of PPE on mobility, consider the following:
  • Ensure the patient has a tightly fitting mask that doesn’t ride up or reduce their field of vision.
  • Clients who wear glasses can use anti-fogging strategies, such as washing with soapy water and drying the glasses without rinsing them.
  • Encourage clients to take their time and look ahead — not down — while walking.
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Virtual Care

Preventing Falls During Virtual Care

Ensuring a safe environment is an important part of falls prevention. With virtual care, it’s more difficult to ensure a safe environment because you don’t have immediate control over the client’s home and can’t easily identify hazards or obstacles. Here are some precautions you can take:
  • Encourage clients who may be at risk for falls to have a support person present during the virtual care appointment to assist with assessments that may require the client to move
  • Ensure clients that require mobility devices have those devices readily available
  • Prior to the appointment, provide client with instructions on how to set-up their home space for the appointment (e.g. moving obstacles)
  • Be able to demonstrate what you need them to do as part of a remote exam
  • Consider a quick safety checklist of the environment (clutter, pets, phone accessible for emergency, walking aids, hearing aids, glasses, proper footwear)
  • Provide clear step-by-step instructions and demonstrations – break them into smaller parts and allow individual to demonstrate back to ensure understanding and mastery
  • Assess the individual’s functioning in daily tasks and self-care, including activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s) through discussion and observation; provide suggestions to improve safety and promote independence

Virtual Etiquette

  • Conduct virtual sessions in a confidential environment.
  • Remove visual distractions behind you.
  • Place camera at eye level and look directly into the camera when possible. This shows clients you’re listening and paying attention.
  • Ensure your ID badge is visible.
  • Be punctual & prepared — gather all relevant patient information prior to starting the session.
  • Ask to be introduced to everyone present in the room, including people who may be off camera.
  • Mute your microphone when you’re not speaking.

Conducting Virtual Care Sessions

To keep virtual conversations organized and productive, create a conversation framework or agenda. You can keep this visible on your computer desktop to refer to during the session. Try to keep agenda items to those with the highest priority.
Acknowledge that clients may feel disappointed that their appointment is being conducted virtually by saying something like “I wish we could be meeting in person.”

Some topics of conversation are difficult to initiate in virtual settings. Ask your client’s permission to discuss difficult topics or when transitioning to new topics.

Providing emotional support to clients can be more challenging in virtual environments. Virtual care may make it harder to read clients’ emotions and demonstrate empathy for them. We’re also not able to use non-verbal supports like touch. To overcome these challenges:

  • Watch and listen for signs your client may be upset, like crying, long pauses or repeating questions
  • Use nodding as a way to show clients you’re listening, even if you may be silent
  • Provide space for the client to express themselves by pausing and waiting for them to speak
  • Take regular pauses to check-in with clients, and ask them for permission to go on with the conversation
During virtual care, issues can arise that make conveying information to clients more difficult (e.g. technical issues, sound quality, memory/comprehension). At the end of the virtual care session, check in with your client to ensure they understand the information you’ve provided. Give them the opportunity to ask questions to clarify anything they may not understand. It may also be helpful to provide additional materials for clients to review on their own time.

Technical Tips

When your voice echoes or reverberates in the room it can make it harder for clients to hear you during video calls. Here are a few ways you can improve sound quality:
  • Use headphones with a microphone (instead of the microphone on your computer) to ensure clear sound quality
  • Test the sound quality of your equipment before appointments, as some equipment can produce unwanted hissing or static noises
  • Place pillows or blankets around your computer area to help “dampen” the sound and reduce echoes, making it easier for clients to hear you
Use books or a box to raise your computer monitor up to eye level – this will allow you to look directly at the camera (instead of the screen). Make sure your face is in view and framed in the centre of the screen so that clients can see your facial expressions clearly.
Make sure you’re well-lit. To do this, sit in front of a light source so that the light is directed at your face. Avoid sitting with your back to a window or other light source – this will cause you to be “back-lit”.
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Tools
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Context
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PPE
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Virtual Care
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This website was developed by a team of researchers at the Daphne Cockwell School of Nursing at Ryerson University. The purpose of the site is to provide supplementary resources for implementing RNAO’s Best Practice Guidelines. Some information about the best practice guidelines has been collected directly from the RNAO BPG website. We have done our best to ensure accuracy, however some discrepancies may occur. For official, up-to-date information about the best practice guidelines, please refer to the RNAO website.