At a recent Town Hall meeting for a CCRC (Continuing Care Retirement Community), I encouraged the residents to read a well-done flier from Front Porch and another one from the CDC on what they could do to reduce their fall risk. Though these documents had been posted in their facility, most were unaware of them. At that point, I stated that falls were the greatest risk to my future health and life expectancy. That may have seemed like an out of place comment, but it certainly got their attention. The administrator agreed to send both documents to their mail boxes (see attached flyers).
After the meeting, I did go on line and found that in 2021, the CDC listed preventable injuries as the 4th leading cause of death. In our facilities, we have tended to look at falls as something to react to, rather than prevent. We may not have empowered our residents, their families, or our front--line staff to recognize fall risks and address those risks proactively. For instance, when I work in an SNF, I commonly see residents out of bed in “gripper socks” universally provided in the acute hospital setting. Even though these socks grip, they don’t provide protection for their feet or a platform for stability while walking. These issues are well known by the rehab team and some nurses, yet our new residents are in gripper socks far too many days.
At the above town hall meeting, I did strongly encourage residents to join a group exercise program that targets improving balance and upper extremity strength since we know that even two sessions a week significantly reduce the risks of fall injuries. What are you doing to educate your residents, their families, and your front-line staff on fall prevention and what they can do to reduce that risk?
On another subject, what are you doing to address the over-prescribing of antibiotics? We know that this remains a rampant problem. For instance, the literature shows that almost 50% of the diagnosis of a significant UTI in our ER’s are not supported by the documented clinical encounter, yet residents and families are told they have a UTI and must take antibiotics. Indeed, most of the time they do well, but would they have done well without the antibiotics? This and other instances of over-prescribing of antibiotics has supported an unrealistic public/staff expectation that antibiotics are the first intervention when there is a change of condition. In terms of UTI’s, we now have good guidance on criteria for making that diagnosis and on the importance of heightened observation, support, and hydration reserving antibiotics for a later time when the evidence for a UTI may be more likely. However, do our front-line staff, residents, and their families know this? Are they aware of the burden of inappropriate use of antibiotics?
To address this issue, the CDC has introduced an excellent educational handout called, “Be Antibiotics Aware” (see attached flier). Having this as a part of your community education program may reduce some of the impetus for the inappropriate use of antibiotics.
Another opportunity that’s quite pressing, is the need to engage front-line staff as well as our families & visitors, on what they can do to reduce the risk of transmitting serious respiratory illnesses to our residents over the winter season. The use of an effective mask (not a surgical or cloth mask) while in direct patient care areas should not only be a public health mandate for our staff during flu season but should be strongly encouraged for our visitors. Vaccinations for Flu, COVID, and RSV should go beyond targeting our residents, but should be strongly encouraged for our staff and visitors who are the most likely initial vectors for these infections. The CDC and CDPH have online public messaging tools that support these community education efforts. What are you doing to reduce the risks of devastating outbreaks in your facilities this winter?
Benjamin Franklin is noted for saying, “an ounce of prevention is worth a pound of cure”. As you think about common preventable problems in your facility, what are the next steps you might take to partner with your staff, residents and communities for their well-being and the success of your facility?