Department of Developmental Services
Office of Quality Management

Living Well
SPRING/SUMMER 2010

 Department of Developmental Services 
Office of Quality Management
Living WELL
Spring/Summer2010

Welcome to the Fall/Winter 2009/2010 issue of "Living Well", a publication of the Department of Developmental Services, Office of Quality Management.   "Living Well" is published on a semi-annual basis and features important information for individuals and their supporters.  

In this edition, you will find helpful information to assist people you support to enjoy spring and summer activities in a safe and healthy manner.

"Living Well” represents one component of DDS's continuing commitment to share information which will safeguard and improve individuals’ quality of life.  Information and knowledge is a powerful tool.  We hope that this and future editions of "Living Well" will be used effectively to enhance the health and well-being of individuals we support.

   We'd welcome your feedback and suggestions regarding content areas for future editions of the publication.  Please submit your suggestions to Sharon.Oxx@state.ma.us.  Thank you!

Elin Howe
Commissioner Department of Developmental Services

Did you know?

Falls Prevention Pilot
DDS conducted a falls prevention pilot for 6 months from March – August 2009. The STOP Falls pilot (Screen Train Observe Prevent Falls) included falls prevention training for staff, a Falls Risk checklist to screen all individuals for falls risk, and post-fall assessments to gather information after each fall. This included information on the time and place of the fall, activity during the fall, and any symptoms experienced by the person before they fell. Five provider agencies volunteered to participate in the pilot. 

What did we learn?
•	Over 900 adults in residential, day supports, and individual supports from these five provider agencies participated. 
•	A total of 473 falls were recorded among participants.
•	About 24% of participants receiving residential or day supports experienced one or more falls during this pilot. 
•	46% of the falls occurred while the person was walking (30% while walking without staff assistance). 
•	The location with the most falls was the common area (23%) where people tend to gather creating traffic flow problems. Many falls also occurred in the bedroom, bathroom, and outdoor areas (including transportation)
•	31% of the falls were caused by a loss of balance by the individual
•	22% of the falls were caused by tripping or slipping
•	Adults over the age of 60 had a higher risk of falling

What’s the good news?  
•	When direct support staff becomes aware of an individual’s risk for falling, they can make a huge difference in preventing them. Committed direct support staff may actually be the most effective tool we have in preventing falls!
•	The simplest changes seem to make the biggest difference. Some examples are:
Look for changes in a person’s medical conditions: If a person is urinating more frequently than usual, they might have Urinary Tract Infection (UTI). This can cause disorientation and unsteadiness. Understand that medications can affect a person’s balance and can increase the risk of falling. STOP Falls results suggest that adults who take more than four prescription drugs have a higher risk of falling than their peers. People are especially at risk of falling after sitting or laying down for an extended period of time, and sometimes for the half hour directly following a meal.
 Increase strength, mobility and balance for all individuals, especially those at risk for falling. The pilot suggests that adults with unsteady balance have 5.0 times the risk of falling compared to other adults with ID. Short walks each day will improve strength and balance. Gentle stretching while sitting or standing can also help.  Provide strengthening exercises for the upper body by using common household items as weights. 
Environmental: Be mindful of environmental hazards that can cause tripping or slipping. Keep clutter out of walkways, secure loose rugs, replace burned out lights. Remove cords and other ripping hazards likebackpacks and alert supervisors if you find broken or unsteady furniture after you remove it from use.Don’t wait for someone else to do it. Your prompt attention to such issues can really save a life.
Stay alert: The pilot found a 33% reduction in the amount of falls over the course of the pilot. While many factors may have contributed to this decrease, keeping staff mindful of falls risk and environmental hazards may have had an impact. 

Remember: If someone looks unsteady when standing or walking, even just momentarily, they may be at risk for falls.

More information can be found in the Quality is No Accident brief on Falls Prevention, and under the “Health and Wellness Promotion” section available on the DDS website

CHOKING 

As summer time approaches and we all look forward to outdoor eating including barbecues, we would like to remind you of some significant choking issue for many of the people we serve. Even if a person does not have a documented choking risk, some foods place all of us at a greater risk

Foods commonly associated with choking:
Meat  is the leading cause of choking incidents and include hamburgers, hotdogs, sandwiches, ham, steak and chicken

As hot dogs in particular have been associated with choking incidents, it is recommended that only skinless hotdogs be served. Those with skin require a stronger bite to break off a piece and thereby can result in too large a portion to chew. They are also harder to chew. Add a soft roll to the mix and the danger just increases.

It is also recommended that skinless hot dogs be sliced lengthwise before serving to those who do not have any special food texture requirements. This may help minimize the risk of choking as the bite will no longer be round and have the potential to block  the airway entirely in a choking episode.

Peanut butter lodged in the throat is extremely difficult to remove. The combination of peanut butter and partially chewed or soft bread can create an obstruction which can block the airway and be fatal. 

Other foods that can present choking hazards include:
Pizza, pasta, potatoes (particularly French fries), Apples, bananas, pineapple chunk, orange slices, grapefruit sections, grapes, marshmallows, rice, potato chips.

Common causes of choking:
•	Eating too fast.
•	Inattention to eating, distraction by other persons or activities.
•	Lack of appropriate supervision.
•	Placing too much food in one’s mouth. 
•	Poor oral motor skills.
•	Incorrect diet texture. If food is to be cut be sure it is in the appropriate size. 
•	Diet is not communicated from setting to setting or to new staff working with the individual.
•	Eating something with two or more diet textures, especially anything with a thin liquid and a solid component such as cereal and milk or eating a hot dog and drinking a soft drink at the same time.

Thank you for your vigilance in these matters. An incident-free summer always holds much better memories for all.

What to do if someone chokes 
•	Follow your first aid training.
•	If individual’s airway is blocked, perform the Heimlich maneuver. This has been extremely successful in dislodging food in the airway. 
•	Even if Heimlich Maneuver is successful, the individual must be seen by a health care practitioner (HCP) following use of this procedure to ensure that there was no injury and that the blockage was completely removed..
•	If breathing problems continue, or Heimlich maneuver is unsuccessful, Call 911. 
•	Continue to monitor someone after a choking or near-choking incident for signs that aspiration pneumonia is developing. Monitor temperature for 48-72 hours after the incident. Contact the HCP if the temperature begins to rise or if a cough develops. Inform the HCP of the recent choking incident.

DEHYDRATION
(The lack of sufficient fluid in the body)

Because many people are on certain medications requiring a stable blood level to maintain effectiveness (like seizure and psychotropic medications), even mild dehydration can cause those blood levels to rise to dangerous levels, even toxic levels. This can create serious health consequences for the individual. Increasing fluid intake on hot days and offering them frequently can help prevent such an event.

Some signs of dehydration include:
•	Decreased amount of urine                                              
•	Less frequent urination 
•	Dry skin or cracked lips
•	Sunken eyes
•	Less elasticity to the skin
•	
•	Fever
•	Sleepiness
•	Headache 
•	Increased heart rate
•	Strong, dark urine 

REMEMBER:  

Popsicles, watermelon, cantaloupe, fruit salad and jello all contain a lot of water and summertime is the perfect time to indulge in such treats. 
HEAT ILLNESSES
•	Heat Cramps occur after vigorous activities like running or playing tennis. Their signs are painful abdominal spasms and cramps in major muscles such as the legs and abdomen. Cramps subside with rest, cooling down and plenty of water. 
•	Heat Exhaustion has many symptoms-fever, heavy sweating, fainting, rapid pulse, low blood pressure, clammy skin, ashen skin tone and nausea. Overexertion and not drinking enough water is the usual cause. To treat it, go indoors with a fan or air conditioning or to a shady spot, apply cool clothes, immediately lie down with your legs elevated, loosen tight clothes, and drink cool water or sports beverages. 
•	Heat Stroke (Sunstroke) can be life-threatening and requires immediate medical help. The symptoms include not only those associated with heat exhaustion, but also very rapid pulse and breathing, delirium, unconsciousness, and lack of perspiration to cool the body. 

      Risk factors for heat stroke include: 
•	Dehydration
•	Age over 65
•	Obesity
•	Consuming alcohol in hot weather
•	Having chronic heart or lung disease
•	Taking medications that interfere with the body’s heat-regulating system

To prevent a heat illness

•	Dehydration
•	Age over 65
•	Obesity
•	Consuming alcohol in hot weather
•	Having chronic heart or lung disease
•	Taking medications that interfere with the body’s heat-regulating system

SUN EXPOSURE
Whenever you or the people you support are in the sun, you need to apply sunscreen. Buy a quality product rated at least SPF (Sun Protection Factor) 30 and  apply it liberally to all exposed skin at least 30-60 minutes before going out into the sun and frequently thereafter especially during peak sun hours or after sweating or swimming. Not only will this help prevent sunburn but skin cancer as well.  

Too much sun is also a risk factor for cataracts, so use sunglasses that block UVA and UVB ultraviolet rays. And don’t forget your wide brimmed hat

Remember,
Certain medications (like anticonvulsants, antipsychotics and high blood pressure medications) can cause people to burn more rapidly and more severely. 

Picnic Checklist

As you head out this summer to enjoy the warm weather and outdoor activities, here is a checklist to help you make sure you have everything you need to make it a safe outing for you and those you support.

 Sunscreen (SPF 30 or greater)

 Plenty of water or caffeine- 
     free beverages 

 Lightweight clothing to cover 
     up if very sunny

 Epipens (if ordered for anyone
     allergic to insects or food)

 First aid kit

 Equipment to allow food to be 
     prepared to correct 
     consistency (if applicable)

 Plenty of gas

 Portable ramp for access (if 
     applicable)

 Information about site you will
     be visiting ( directions, 
     bathroom access, parking, wc 
     access, etc.)

 Towels if swimming planned	
 Bug spray

 Fully charged cell phone for 
     emergencies

 Emergency fact sheets for all 
     individuals

 Lots of ice and coolers to keep 
     cold foods cold

 Hats to protect from the sun

 Food that can be safely 
     maintained in hot weather (to 
     prevent food poisoning)

 Enough staff to assure safety

 Adapted utensils (if applicable)

 Change of clothes for 
     swimmers or those with 
     toileting issues

 Blankets and chairs for 
     seating

CREEPY CRAWLEES and OTHER PESTS

•	Bee, wasp or hornet stings can cause a medical emergency if one is allergic to them. You should be aware of those you are responsible for who have this problem and make sure you know what to do if they get stung. Most people, however, only experience a sharp pain that goes away after a few minutes. It is important to remove the stinger promptly: use a flat edge such as a credit card to scrape it from the welt, Wash the area and apply ice. Continue to monitor for signs of infection or increased inflammation.
•	Deer ticks are tiny insects that live in low brush and can spread Lyme disease in a small percentage of the people they bite. Use bug repellant with DEET whenever out in such areas to keep these pests and others away. Wear a long-sleeved shirt, long pants, socks and a hat if you are in tick country. When you get home, carefully check yourself and the person you support for ticks. And don’t panic! Generally, a Lyme disease carrying tick usually has to be attached for at least 24 hours to spread the disease. Ticks can be difficult to kill so it is best to flush them whenever possible.
•	Mosquitoes: Avoid outdoor activities at dusk or dawn. That is when they are most active. Use a mosquito repellant. Most repellants are effective for many hours so there is no need to keep reapplying it. Wash it off carefully after going back inside. Wear light-colored clothing as mosquitoes are attracted to dark or bright colors.

If you would like further information on these topics or others, we suggest you visit the following website:

                                   www.state.ma.us/dph

MAP Reminder:

A HCP order is Not needed for the use of 
Bug Spray  
or 
Sunscreen

WATER  SAFETY

Enjoying the water can be a special way to enjoy warm, summer days.  With some precautions and planning as outlined below, these activities can be the basis of happy memories of a fun summer.  

•	Assess each individual’s capabilities and needs when using different water venues, such as a pool, the ocean, or boating.  Ensure staff is knowledgeable of people’s capabilities and staff has water safety skills to support individuals while enjoying water activities. 

•	Know each individual’s vulnerabilities and provide ongoing supervision to ensure everyone’s safety.  Remember, in sight supervision must be provided at all times to fully ensure safety.  

•	Before use, identify and utilize other available resources to ensure safety such as Lifeguard over sight of the beach or pool

•	Before use, identify any potential hazards and unique safeguards required for the specific water environments individuals will be using.  Potential hazards, for example, could include finding out about surf conditions to determine whether swimming in the ocean is safe, or knowing the depth of the water or possible underwater hazards when swimming at a lake or river. Safeguards would include the use of life jackets when boating.

•	Watch out for the “dangerous too’s”—too tired, too cold, too far from safety, too much sun, too much strenuous activity.

•	Pay attention to the weather and stop swimming at the first indication of bad weather.  Know what to do in an electrical storm.  Upon the first sign of thunder or lightning, leave the water, and do not re-enter the water until at least twenty minutes after the last indication that a storm is present.  

•	For pools at individuals’ homes, ensure that the pool is maintained safely and that safeguards are in place when the pool is temporarily or seasonally not in use.  For more information, refer to the DDS’s “Safeguards for Pools” issued on 1/8/97.

•	Even wading pools can pose a danger. Make sure the surfaces are not slippery as people step into the pool. Apply nonskid bathtub decals to reduce this risk. Ensure that individuals are well-supervised when using the pool, and empty the wading pools when not in use.