Slips, Falls and Fractures

Elderly Couple Walking

A simple fall can change your life. Just ask any of the thousands of older men and women who fall each year and break a bone. Falling is the number one cause of death due to injury for people over 75 years old and the second leading cause of death due to an injury among those 45-75 years old.

Over 80% of fatal slips and falls occurred among seniors, ages 65 or older. Though falls are more devastating to seniors, they can be just as fatal to younger people, regardless of age.

Risk Factors for Injurious Falls Client’s Reduction Risk
Risk – By evaluating one’s risk for falls, he/she can make accommodations to reduce that risk Intervention – The more you take care of your overall health and well-being, the more likely you’ll be to lower your chances of falling.
Impaired vision or hearing Have your vision and hearing tested often. Even small changes in sight and hearing can make you less stable. So, for example, if your doctor orders new eyeglasses, take time to get used to them, and always wear them when you should or, if you need a hearing aid, be sure it fits well.
Cognitive impairment, impaired judgment, confusion, disorientation Consider hiring a caregiver to keep the client safe.
Impaired balance, gait, or strength

Impaired mobility or range of motion, limited activity tolerance

Neurological problems such as stroke, Parkinson’s disease, and syncope

Musculoskeletal problems such as arthritis, joint replacement, deformity, and foot problems

Always stand up slowly after eating, lying down, or resting. Getting up too quickly can cause your blood pressure to drop, which can make you feel faint.

Limit the amount of alcohol you drink. Even a small amount can affect your balance and reflexes.

Use a cane, walking stick, or walker to help you feel steadier when you walk. This is very important when you’re walking in areas you don’t know well or in places where the walkways are uneven. And be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas.

Talk with your doctor and plan an exercise program that is right for you. Regular exercise helps keep you strong and improves muscle tone. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing exercise—such as walking, climbing stairs—may even slow bone loss from osteoporosis.

Chronic diseases such as osteoporosis, cardiovascular disease, lung disease, and diabetes Ask your doctor about a special test—called a bone mineral density test—that tells how strong your bones are. If need be, your doctor can prescribe new medications that will help make your bones stronger and harder to break.
Medications (more than four prescription medications and blood pressure lowering medications) Find out about the possible side effects of medicines you take. Some medicines might affect your coordination, balance or blood pressure. If so, ask your doctor or pharmacist what you can do to lessen your chance of falling.


Find out about buying a home monitoring system service. If you fall or need emergency help, you just push the button to alert the service.

Orient yourself to any new environment.

Stay away from a freshly washed floor.

Don’t stand on a chair or table to reach something that’s too high—use a “reach stick” instead.

Hold the handrails when you use the stairs. If you must carry something while you’re going up or down, hold it in one hand and use the handrail with the other.

Wear rubber-soled, low-heeled shoes that fully support your feet. Keep walkways obstruction and spill free.

Don’t let your home get too cold or too hot… it can make you dizzy. Get more than five hours of sleep every night. If you are over the age of 70 and get fewer than five hours of rest per night, you are more prone to falling.

Environmental Risk Reduction

You can help prevent falls by making changes to unsafe areas in your home. Take a look around your home. Your living room, kitchen, bedroom, bathroom, hallways and stairways may be filled with hazards. To make your home safer:

In all living areas

  • Make sure there is good lighting with light switches at the top and bottom of the stairs.
  • Keep areas where you walk tidy. Maintain carpeting and floorboards.
  • Pick up toys or other objects from the floor to clear your path. Keep electric cords and phone wires away from walking paths.
  • Arrange furniture so they are not in your walking path.
  • Have handrails on both sides of all stairs—from top to bottom—and be sure they’re tightly fastened.
  • Keep light switches and telephone near your bed.

In bathrooms and powder rooms:

  • Mount grab bars near toilets and on both the inside and outside of your tub and shower.
  • Place non-skid mats, strips, or carpet on all surfaces that may get wet.
  • Keep night lights on.
  • Don’t attempt to place a child in or take them out of the tub by yourself. Once a child is over 20 pounds it becomes dangerous to both of you to attempt this.

When a Fall Occurs

The majority of people do not see their doctor after falling, although doing so is vital to a good recovery and the prevention of future falls. Recovering from a slip-and-fall accident is multi-pronged and may involve physical therapy, exercises, rest and analgesics.

The staff member discovering the fall will attend to the patient’s immediate needs:

  1. A nurse will assess the client immediately. Provide appropriate first aid measures, stop any bleeding, apply ice to bruises, bumps or cuts.
  2. If there is a suspected broken bone, keep the client still and call for transport to the hospital.
  3. Notify the attending Physician promptly to determine the need for further evaluation.
  4. Neurological checks and vital signs as ordered or appropriate for injury.
  5. The client’s family will be notified of any fall, including injuries in a timely manner.
  6. The fall will be documented in the progress notes.
  7. The caregiver witnessing a fall or finding a patient after an un-witnessed fall will complete an incident report and send to the Nurse Manager or designee.
  8. Teaching about falls and safety will be reinforced to client and family as needed.
  9. Continue to assess client for any unidentified injury and for response to treatments or recovery.

For individuals after a fall or slip injury:

  • Make an appointment with your doctor. He will make sure you have not sustained any injuries. The doctor will check your medications and look for any that have dizziness as a side effect. He may recommend an appointment with an ophthalmologist or eye doctor.
  • Follow your physician’s recommendations. Use hot or cold packs and analgesic medication as directed.
  • Keep your appointment with a physical or occupational therapist. These professionals will show you how to do simple exercises to help you heal from any injuries. They also may recommend exercises to improve your balance and teach you how to get up properly if you do fall. Tai chi, walking and strength training may be suggested.
  • Use properly fitting adaptive equipment, such as a walker or cane, as recommended by the physical or occupational therapist. Do not borrow this equipment from a friend or family member; it must be fit to your body. The therapist also may suggest sitting on a wedge, lowering your bed and elevating your toilet seat.
  • The physical therapist can analyze your home for hazards. He may suggest backing your throw rugs with non-slip grip matting or getting rid of them completely. Other recommendations may include fixing any loose carpet or flooring and keeping clutter picked up off the floor.


Chain of Infection


Development of an infection is dependent upon an uninterrupted process, referred to as – chain of infection. This process is dependent upon the following elements:

  • pathogens in sufficient numbers
  • a reservoir for pathogen growth
  • a portal of exit from the reservoir
  • a mode of transmission
  • a portal of entry to the host, and
  • a susceptible host

This chain of infection can be broken by infection control measures implemented by health care workers. These measures either terminate the threat or block the mechanism leading to the next link in the chain. An infection may be stopped at any point in the chain of infection.

How does the Chain of Infection Work?

A reservoir is any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such manner that it can be transmitted to a susceptible host. There can be Animate reservoirs include people, insects, birds, and other animals. Inanimate reservoirs include soil, water, food, feces, intravenous fluid and equipment.

The pathogen then leaves the reservoir via the portal of exit. This is the site from where micro-organisms leave one host to enter another host and cause disease or infection. For example, a micro-organism may leave the reservoir through the nose or mouth when someone sneezes or coughs, or in feces. Ports of exit include: Upper respiratory tract, Gastrointestinal tract, Blood, Urogenital tract, Skin and mucous membranes.

Once a pathogen has exited the reservoir, it needs a mode of transmission to the host through a portal of entry. Transmission can be by direct or indirect contact or through airborne transmission.

Direct contact is person-to-person transmission of pathogens through touching, biting, kissing, or sexual intercourse. Microorganisms can also be expelled from the body by coughing, sneezing or talking. The organisms travel in droplets over less than 1 meter in distance and are inhaled by a susceptible host.

Indirect contact includes both vehicle-borne and vector-borne contact. A vehicle is an inanimate go-between, an intermediary between the portal of exit from the reservoir and the portal of entry to the host. Inanimate objects such as handkerchiefs and tissues, soiled laundry, and surgical instruments and dressings are common vehicles that can transmit infection.

The infectious agents then enter the body through a portal of entry. After an infectious agent gets inside the body it has to multiply in order to cause the disease. In some hosts, infection leads to the disease developing, but in others it does not. Individuals who are likely to develop a communicable disease after exposure are calledsusceptible hosts. This is due to a low level of immunity within the more susceptible individuals. Immunity refers to the resistance of an individual to communicable diseases, because their white blood cells and antibodies (defensive proteins) are able to fight the infectious agents successfully. Low levels of immunity could be due to:

  • diseases which suppress immunity
  • individuals receiving chemotherapy
  • poorly developed or immature immunity, as in very young children
  • not being vaccinated
  • poor nutritional status
  • pregnancy

Breaking the Chain of Infection:

The chain of infection can be broken and infection avoided or disrupted by breaking any one of the links within the chain. For instance, healthcare workers may avoid the transmission of pathogens by using standard precautions. Immunization against common pathogens such as influenza, measles and pertussis will thwart may viral agents. Additional examples follow:

  • Correct hand hygiene is the most important basic practice for the prevention of transmission of pathogens
  • Maintenance of skin and mucous membrane integrity (caregiver and client)
  • Apply standard precautions when handling excreta, exudate, and soiled linen.
  • Cleaning, disinfection, and sterilization of reusable instruments and equipment
  • Maintenance of aseptic techniques, use of sterile equipment or single use equipment
  • Elimination of sources of infection (reservoirs)
  • Early diagnosis of infectious diseases (decreased number of pathogens for transmission)
  • Isolation of persons suffering from infectious diseases
  • Appropriate handling and disposal of body secretions – vomitus, feces, sputum, blood and body fluids
  • Cover nose and mouth when sneezing or coughing, and dispose of facial tissues after use
  • Immunization against infectious diseases
  • Collection and disposal of waste in communities, adequate drainage and sewerage facilities

Clean Hands Save Lives

Clean Hands


Wash your hands How many dozens of times have you heard this? Did you stop listening to what may sound like a broken record? I ask you now to please take a minute to reflect on the real impact that unsanitary hands can have on you, your patients and your family. MRSA infections are on the rise outside of hospitals and it is more important than ever to be diligent about hand washing. Here’s a refresher for you:

Your skin constantly makes oil that stay on the surface. Germs stick to your skin by getting trapped in the oil. That is why it’s important to use soap and water or an alcohol based hand sanitizer. Sanitizing gel is acceptable to use if you hands are not visibly soiled.

When to wash in the clinical setting:

  • Before direct contact with patients
  • Before donning sterile gloves for any procedure
  • After removing gloves
  • After contact with a pt’s intact skin
  • After contact with body fluids, excretions or mucous membranes
  • If moving from a contaminated body site to clean body site during patient care
  • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
  • Before eating or after using the restroom

When to wash in the home setting:

  • Before you insert or remove contact lenses
  • After handling raw foods
  • After you touch an animal or handle garbage
  • After you blow you nose
  • Whenever you care for an ill/injured person or animal
  • When children return home from school or play

How you do it makes a difference!

  • Use soap and warm running water
  • Take at least 15 seconds to do the washing (sing Happy Birthday to yourself)
  • Wash all surfaces, including wrist, palm, backs, between fingers and all around the fingernails
  • Use disposable paper towels

There is no time like now to renew good habits. Let’s all make it a priority to protect ourselves, our families and our patients with a personal commitment to consistently clean hands.


See video below:

Completing an MD Order

MD Order Form

One of the major causes of medication errors occurs between the person giving the orders, the understanding of what is said and the writing of the order. These miscommunications have the potential of being devastating to the client if a wrong medication or dose is given. This is especially true when one considers the majority of our clients are pediatric and even the smallest error can impact the outcome of the client.

This new form will remind us and prompt us to gather the information more accurately, completely and with additional safe guards to ensure the clarity of all orders. Please replace the old forms in the home with the new ones we have devised.


  1. Complete the client’s name and date of birth.
  2. Complete the name, address, phone number and fax number of the physician responsible for the orders.
  3. Remember to write the orders without the use of the prohibited abbreviations as listed on the form.
  4. Write the orders down on the form LEGIBLY.
  5. Read back orders to the physician or their delegate to confirm accuracy. This means you have written the order down and are READING it back not just repeating it back.
  6. Keep in mind and pay close attention if any of the orders contain any look alike or sound alike medications.
  7. Spell back all medications if there is any question of their spelling.
  8. Indicate who gave the order. Get their first and last names and credentials. Place this information in the area: “Orders given by..” Date the order.
  9. Sign the order with your credentials and date it.
  10. Check the box indicating that you did indeed read the orders back to verify accuracy.
  11. Indicate the purpose of the medication/order on the MD order form: “Client status/reason for order.”
  12. Determine the purpose of the medication before administration.
  13. Complete the loop: provide the new orders to the oncoming care- givers, include a copy of the order in the chart, add the new order onto medications administration sheets or task sheets as appropriate, include the information in the communication book, report the new order verbally to the next caregiver and why it was ordered, inform suppliers if needed, send the original into the office.
  14. AND don’t forget to provide instruction and education to the client/caregiver regarding a new medication, side effects, adverse reactions, dosage, etc.
  15. Indicate you teaching directly on the MD order form.

By Janet Fulfs, President

Also, please see video below:


Nursing Talk

Dear Cassandra:

My husband says I should wear “sensible” shoes to work. My shoe collection could rival that of Imelda Marcos. I have three inch stiletto heels, platform shoes, sandals, wedges, mules, ballerina slippers, flip flops, Crocs, flats, cowboy boots, and more.

When I was a teenager, I considered becoming a Dominican nun. My teacher, Sister Mary Catherine, invited me to visit the motherhouse and to learn about the life of a novitiate. I could accept the habit, the celibacy, the prayer, the silence, the service to others. But the shoes! How could I spend my entire life in lace-up black shoes?

What do you think?



Dear Diane:

A recent study revealed that the average woman buys 469 pair of shoes during her lifetime for a total cost of $25,000. Your fascination with shoes does seem excessive even by those standards.

Before you end up in the hospital with a broken ankle or sprained back because you slipped on ice in a driveway or tripped over toys on the floor at your client’s house, listen to your husband. Wear sensible shoes to work. No high heels, no open toe shoes, no sandals, no flip flops. Besides, painted toe nails in open toe sandals don’t look good covered with vomit.


Note: First published on American Home Health's news, August 2010. 


Emission Testing
Emission Testing


 It’s funny how sometimes you find out important things simply by accident.  You are at the beauty shop or barber shop.  The conversations revolve around the presidential debates, the Super Bowl, upcoming vacations, and new grandchildren.  Then someone mentions something that can impact every driver in the state of Illinois.  WHOA!


The Illinois EPA and the Secretary of State’s office are also implementing a change in the enforcement process of the testing program, as required by Public Act 94-0848.  Beginning in January, 2008, vehicles must pass an emissions test or otherwise comply with the Illinois Vehicle Inspection Law of 2005 before the registration (license plate) can be renewed.  Previously, the program was enforced through the suspension of drivers’ licenses and vehicles’ registration.

Due to these changes, some vehicles will be required to comply prior to the expiration date printed on the current Vehicle Inspection Report or Emissions Test Certificate.  Generally, vehicles over four years old will still need to be tested every two years (even model year vehicles during even calendar years and odd model year vehicles during odd calendar years).

For more information about vehicle emissions test enforcement and your license plates, go to the Illinois EPA Web site at .         

by Karen Centowski