# Video 1: Performing a Balance Assessment

The *Performing a Balance Assessment* video is designed to teach
rehabilitation therapists about performing functional assessments
relating to falls. Also included with the video is a handbook that
provides more detailed explanations of each of the functional
assessments. The therapists watching this video should have a copy of
the balance assessment handbook and a pencil or pen to take notes.

IMPORTANT:

Only rehabilitation therapists should perform this assessment. This
includes physical therapists, occupational therapists and
kinesiotherapists.

*Audience*: Rehabilitation Therapists

*Materials Needed*: Balance Assessment Handbook (see Falls Toolkit Web
site educational resources) and pencil or pen

# Video 2: Hip Protectors in an Inpatient Setting

The video *Hip Protectors in an Inpatient Setting* is designed for
nursing staff to raise awareness about hip protectors and their place in
a falls prevention program. Nursing staff will learn about what is
included in a falls prevention program, how to choose hip protectors for
patients, how to size patients for hip protectors and instructions on
how to wash hip protectors.

*Audience*: Nursing staff, including RNs, LPNs and NAs

*Materials Needed*: Hip protector information package (see following
pages) and a pencil or pen

## Hip Protector Information Package

**[Introduction]{.underline}**:

This handout accompanies a video providing you with information about
hip protectors so that, if decided, you can implement their usage at
your VA medical center. This handout contains factual information as it
is presented in the video, but is not a direct outline of the video. Use
this handout as a supplement while watching the video or during
follow-up discussions.

At the end of this handout is a section entitled Success Factors, which
contains comments and opinions of teams who trialed different types of
hip protectors on select patient units during an NCPS initiative called
the Hip Protector Quality Improvement Project. This information does not
appear in the video.

Implementing hip protectors can be challenging. Keep in mind that many
VA medical centers currently use hip protectors and are eager to share
their success factors.

**[General Information about Falls, Fractures, and
Prevention:]{.underline}**

> • Hip fractures result from lateral falls with greater impact on
> trochanter or proximal femur.
>
> • 3 to 5% of falls in older adults result in fractures, and this
> percentage increases for inpatients due to prevalence of osteoporosis.
>
> • Fractures lead to patient decline in functional ability and
> independence.
>
> • About ½ of the patients who fall don't return to their previous
> level of functioning and 20-30% die within one year.

• Restraints are not effective fall prevention measures. They drain
nursing resources, cause patients to lose muscle strength, and can
potentially cause entrapment.

> • VA wants veterans to be as mobile as possible and this means they
> may fall more often.
>
> • Hip protectors reduce risk of serious injury from these falls.

**[Hip Protectors:]{.underline}**

Hip protectors are designed to prevent trochanter fractures during
patient falls.

Research studies show that hip protectors can significantly reduce
patient injuries. Six studies found a lower risk of fracture in the
patient group wearing hip protectors. Three of these studies reported no
hip fractures while patients were wearing hip protectors.

Two manufacturers of hip protectors are **HipSaver™** and **Posey™.**

There are several different models available by these manufacturers.
These models are designed to meet the varying needs of different
patients.

### 

### HipSaver™ Models

> • *SlimFit™* -- designed mostly for outpatients. The material is
> stretchy and form fitting. This model is also available with a male
> fly front.
>
> • *Nursing Home* -- designed for nursing home patients. The material
> is less stretchy than the SlimFit*™* model. It has larger leg openings
> so that it is easier for patients with less mobility. This model is
> also available with a male fly front.
>
> • *QuickChange™* -- designed for incontinent patients or for
> self-toileting patients who have difficulty moving the hip protector
> up or down. This model has two snaps in the front of the garment. This
> model is good for patients who are able to stand while they are being
> changed.
>
> • *Wrap&Snap™* -- designed for patients who are unable to stand while
> they are being changed, because the garment can be laid flat
> underneath them and snapped around them. Some self-toileting patients
> may also like this model.
>
> • *Open-Bottom™* -- designed for self-toileting patients who are not
> able to pull the hip protectors up and down. The model is available
> with or without Velcro. The Velcro model can be wrapped around a
> patient, while the non-Velcro model is pulled up.

### 

### Posey™ Models

> • *Hipster™ III* (#6016) -- The standard model for continent patients.
>
> • *Hipster™ Incontinent* (#6017) -- This model features a snap front
> for easy application while the patient is lying in bed.
>
> • *Hipster™ Fly Front* (#6018) -- This model features a fly front and
> is white rather than the usual beige color.
>
> • *EZ On* (#6019) -- This model is mesh and has a Velcro closure
> around the waist and each leg. It is designed for patients who may be
> at risk for falling while toileting or while in the shower.

**[Choosing the Right Models for Patients:]{.underline}**

After determining which patients need hip protectors using fall risk
assessments (such as the Morse or Hendricks fall risk assessments or
another method), find the appropriate hip protector model for the
patient. Patient characteristics that will influence hip protector model
choice include: patient continence level, weak grip strength, or
cognitive impairment.

HipSaver™ Quick Checklist (table below)

 = Model designed with this particular patient type in mind

 = Model also works with this patient type

+-----------------+-------+-------+-----+-------+-----+--------+-----+
|                 | Pa    |       |     |       |     |        |     |
|                 | tient |       |     |       |     |        |     |
|                 | Chara |       |     |       |     |        |     |
|                 | cteri |       |     |       |     |        |     |
|                 | stics |       |     |       |     |        |     |
+-----------------+-------+-------+-----+-------+-----+--------+-----+
| Models          | >     | >     | >   | > Li  | > W | > De   | >   |
|                 | Outpa |  Self |  In | mited | eak | mentia |  Re |
|                 | tient | >     | con | > Mob | > G | > /    | hab |
|                 |       |  Toil | tin | ility | rip | > Cog  | >   |
|                 |       | eting | ent |       |     | nitive |  Pa |
|                 |       |       |     |       |     | > Impa | tie |
|                 |       |       |     |       |     | irment | nts |
+-----------------+-------+-------+-----+-------+-----+--------+-----+
| SlimFit™        |      |      |     |       |     |        |     |
+-----------------+-------+-------+-----+-------+-----+--------+-----+
| Nursing Home    |      |      |     |      |     |        |     |
+-----------------+-------+-------+-----+-------+-----+--------+-----+
| QuickChange™    |      |      |    |      |    |       |    |
+-----------------+-------+-------+-----+-------+-----+--------+-----+
| Wrap&Snap™      |      |      |    |      |     |       |     |
+-----------------+-------+-------+-----+-------+-----+--------+-----+
| OpenBottom™     |      |      |     |      |    |       |    |
+-----------------+-------+-------+-----+-------+-----+--------+-----+

Posey™ Quick Checklist (table below)

 = Model was designed with the particular patient type in mind

 = Model is also useful with this patient type

+--------------+----+-------+----+------+------+------------+--------+
|              | P  |       |    |      |      |            |        |
|              | at |       |    |      |      |            |        |
|              | ie |       |    |      |      |            |        |
|              | nt |       |    |      |      |            |        |
|              | C  |       |    |      |      |            |        |
|              | ha |       |    |      |      |            |        |
|              | ra |       |    |      |      |            |        |
|              | ct |       |    |      |      |            |        |
|              | er |       |    |      |      |            |        |
|              | is |       |    |      |      |            |        |
|              | ti |       |    |      |      |            |        |
|              | cs |       |    |      |      |            |        |
+--------------+----+-------+----+------+------+------------+--------+
| Models       | >  | >     | >  | >    | >    | > Dementia | >      |
|              | Ou |  Self |  I |  Lim | Weak | > /        |  Rehab |
|              | tp | >     | nc | ited | >    | >          | > Pa   |
|              | at |  Toil | on | >    | Grip |  Cognitive | tients |
|              | ie | eting | ti | Mobi |      | >          |        |
|              | nt |       | ne | lity |      | Impairment |        |
|              |    |       | nt |      |      |            |        |
+--------------+----+-------+----+------+------+------------+--------+
| Hipster^TM^  |   |      |    |      |      |            |        |
| III          |    |       |    |      |      |            |        |
+--------------+----+-------+----+------+------+------------+--------+
| Incontinent  |   |      |   |     |     |            |       |
+--------------+----+-------+----+------+------+------------+--------+
| Fly Front    |   |      |    |      |      |            |        |
+--------------+----+-------+----+------+------+------------+--------+
| Easy-On      |   |      |   |     |     |           |       |
+--------------+----+-------+----+------+------+------------+--------+

**[Choosing the Right Model for Patients Con't:]{.underline}**

*HipSaver^TM^ vs. Posey^TM^ Checklists (table below)*

>  = Model was designed with the particular patient type in mind
>
>  = Model is also useful with this patient type
>
>  = Option available on model considers this patient type

<table style="width:100%;">
<colgroup>
<col style="width: 22%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 11%" />
<col style="width: 10%" />
<col style="width: 9%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><strong>Models</strong></td>
<td colspan="9"><strong>Patient Characteristics</strong></td>
</tr>
<tr class="even">
<td><h4 id="outpatient">Outpatient</h4></td>
<td><blockquote>
<p><strong>Self Toileting</strong></p>
</blockquote></td>
<td><h5 id="incontinent">Incontinent</h5></td>
<td><blockquote>
<p><strong>Limited Mobility</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>Weak Grip</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>Dementia/ Cognitive Impairment</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>Rehab Patients</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>6 feet tall or more</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>Male Patient</strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>HipSaver<sup>TM</sup> Models</strong></td>
</tr>
<tr class="even">
<td>SlimFit™</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Nursing Home</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>QuickChange™</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Wrap&amp;Snap™</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Open Bottom™</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>Posey<sup>TM</sup> Models</strong></td>
</tr>
<tr class="even">
<td>Hipster™ III</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Incontinent</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Fly Front</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>EZ On</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**[Sizing Hip Protectors:]{.underline}**

### 

### HipSaver™ Determining Correct Size Hip Protector for a Patient

Measure patient around the hip. If patient uses incontinent products,
measure the patient's hip while he or she is wearing that product.

  ---------------- ----------------------------- ----------- ----------------------
  **HipSaver^TM^                                             
  Sizing Chart**                                             

  **Hip                                          **Hip       
  Measurement**                                  Protector   
                                                 Size**      

  **Inches**       **Approximate Centimeters**               

  28" -- 31"       71.1 cm -- 78.7 cm            XS          Extra Small

  32" -- 35"       81.3 cm -- 88.9 cm            S           Small

  36" -- 39"       91.4 cm -- 99.1 cm            M           Medium

  40" -- 44"       101.6 cm -- 111.8 cm          L           Large

  45" -- 50"       114.3 cm -- 127 cm            XL          Extra Large

  51" -- 57"       129.5 cm -- 144.8 cm          XXL         Extra Extra Large
  ---------------- ----------------------------- ----------- ----------------------

**[Sizing Hip Protectors Con't:]{.underline}**

Posey™ Determining Correct Size Hip Protector for a Patient

Posey Hipsters™ are sized differently from HipSavers™. A measurement is
taken from around the waist and around the hips.

  --------------- ----------------- --------------- ----------------- ----------- --------------
  **Posey^TM^                                                                     
  Sizing Chart --                                                                 
  Female Patients                                                                 
  Only**                                                                          

  **Waist                           **Hip                             **Hip       
  Measurement**                     Measurement**                     Protector   
                                                                      Size**      

  **Inches**      **Approx.         **Inches**      **Approx.                     
                  Centimeters**                     Centimeters**                 

  28" -- 30"      71.1 cm -- 76.2   35" -- 37"      88.9 cm -- 94 cm  S           Small
                  cm                                                              

  32" -- 34"      81.3 cm -- 86.4   39" -- 41"      99.1 cm -- 101.4  M           Medium
                  cm                                cm                            

  36" -- 38"      91.4 cm -- 96.5   43" -- 45"      109.2 cm -- 114.3 L           Large
                  cm                                cm                            

  40" -- 42"      101.6 cm -- 106.8 47" -- 49"      119.4 cm -- 124.5 XL          Extra Large
                  cm                                cm                            

  44" -- 48"      111.8 cm -- 121.9 51" -- 53"      129.5 cm -- 134.6 XXL         Extra Extra
                  cm                                cm                            Large
  --------------- ----------------- --------------- ----------------- ----------- --------------

*Sizing Comparison Between HipSaver^TM^ and Posey^TM^*

  --------------- --------------- --------------- --------------- ---------- --------------- ---------------
  **Size                                                                                     
  Comparison**                                                                               

  **Posey™ Waist                  **Posey™ Hip                    **Size**   **HipSaver™ Hip 
  Measurement**                   Measurement**                              Measurement**   

  **Inches**      **Approx.       **Inches**      **Approx.                  **Inches**      **Approx.
                  Centimeters**                   Centimeters**                              Centimeters**

                                                                  XS         28" -- 31"      71.1 cm -- 78.7
                                                                                             cm

  28" -- 30"      71.1 cm -- 76.2 35" -- 37"      88.9 cm -- 94   S          32" -- 35"      81.3 cm -- 88.9
                  cm                              cm                                         cm

  32" -- 34"      81.3 cm -- 86.4 39" -- 41"      99.1 cm --      M          36" -- 39"      91.4 cm -- 99.1
                  cm                              101.4 cm                                   cm

  36" -- 38"      91.4 cm -- 96.5 43" -- 45"      109.2 cm --     L          40" -- 44"      101.6 cm --
                  cm                              114.3 cm                                   111.8 cm

  40" -- 42"      101.6 cm --     47" -- 49"      119.4 cm --     XL         45" -- 50"      114.3 cm -- 127
                  106.8 cm                        124.5 cm                                   cm

  44" -- 48"      111.8 cm --     51" -- 53"      129.5 cm --     XXL        51" -- 57"      129.5 cm --
                  121.9 cm                        134.6 cm                                   144.8 cm
  --------------- --------------- --------------- --------------- ---------- --------------- ---------------

**[Monitoring Patients Wearing Hip Protectors:]{.underline}**

-   Look for skin irritation, changes in patient continence, or signs of
    patient discomfort.

-   Adjust hip protector models and usage accordingly.

**[Laundering Hip Protectors:]{.underline}**

The following laundry instructions may prevent the spread of hospital
infections.

  ---------------------------------- -- ----------------------------------
  **Washing Hip Protectors on the       **Washing Hip Protectors in
  Unit**                                Hospital Laundry**

  Wash with regular detergent and a     Wash and dry in clothing/pajama's
  small amount of bleach. **Note:       cycle. Use heavy soil cycle *only*
  Dissolve bleach in water prior to     as necessary
  putting hip protectors in the         
  machine.** Or, wash with detergent    
  supplied by the laundry service       
  for washing clothes on the unit.      
  Dry at 160^0^ Fahrenheit              
  ---------------------------------- -- ----------------------------------

If using the hospital laundry, consider purchasing mesh laundry bags to
ensure that the hip protectors stay together and are returned to the
correct unit or facility. Mesh bags are also useful if laundry gets sent
to another facility. Consider using special bins for the hip protectors
so that they are always together. If you do this, make sure that the
facility management and laundry people know what the bins are for and
that they need to pick them up daily to ensure the hip protectors get
washed in timely fashion.

### HipSaver™ Laundry Notes

Choosing the right hip protectors is important for both the patients and
the staff. Consider your laundry facilities prior to purchasing hip
protectors. HipSaver^TM^ hip protectors can be washed in hospital
laundry facilities. Additionally, using small amounts of bleach does not
degrade the products quickly. Drying temperatures should be low. The hip
protectors should be removed promptly from the dryer, especially if
using the hospital or a commercial/industrial laundry.

*Posey™ Laundry Notes*

As a general rule, Posey™ hip protectors should not be washed in the
hospital laundry. They degrade more quickly and pads may crack or
dissolve. Bleach appears to accelerate this degrading process. However,
if necessary, small amounts of bleach should be used. Hip protectors
should be dried in low heat and removed promptly from the dryer.

If the hip protectors come with removable pads, then remove pads and
wipe them clean using a mild, liquid disinfectant. The pads may be
removable because they do not tolerate washing conditions well and may
disintegrate.

**[Contact Manufacturers:]{.underline}**

### 

### HipSaver™ Contact Information

+--------------+---------------+--------------------------------------+
| Ed Goodwin   | Helen Brogna  | Phone: 1-800-358-4477                |
|              |               |                                      |
| President    | Vice          | E-mail: <hipsavers@msn.com>          |
|              | President     |                                      |
| HipSaver™    |               | Website:                             |
| Inc.         | HipSaver™     | [www.hip                             |
|              | Inc.          | saver.com](http://www.hipsaver.com/) |
+--------------+---------------+--------------------------------------+

### Posey™ Contact Information

+-------------------------+--------------------------------------------+
| Gary Platzman           | Phone: 1-800-447-6739 extension 193        |
|                         |                                            |
| Vice President, Sales   | E-mail: <gplatzman@posey.com>              |
|                         |                                            |
| Posey™ Company          | Web Site: www.posey.com                    |
+-------------------------+--------------------------------------------+

**[Success Factors:]{.underline}**

Facilities participating in the Hip Protector Quality Improvement
Project identified factors that lead to successful implementation of hip
protectors. The following success factors apply specifically to the
choice of hip protector models:

-   *Start with a small number of a variety of hip protectors and allow
    the staff to use them in the care setting. Use recommendations from
    staff and patients to make a final decision on the models of hip
    protectors purchased.*

-   *Allowing nursing staff and patients to have more input on
    implementation process increases the likelihood that they will
    comply with hip protector use.*

-   *Ensure that there are at least two different models available, for
    example having both an incontinent and continent version available
    for patients to choose. This allows both patients and caregivers to
    have a choice in the models that they use, increasing the likelihood
    that they will use hip protectors.*

-   *Allow patients to switch between the models available. This allows
    patients to choose the hip protector model that works best for
    them.*

-   *One facility found that patients who were continent would start off
    wearing the incontinent brief, switch to the continent brief then
    switch back again when they found that it was easier to use the
    incontinent brief.*

-   *When telling patients about the different models available, refer
    to the models in non-stigmatizing language, such as brief with snaps
    versus the brief without snaps. This reduces the stigma associated
    with incontinence, allowing patients to use the hip protector that
    best meets their need.*

Facilities identified some success factors directly related to the
logistics of implementing hip protectors:

-   *Implement hip protectors using a team that includes
    laundry/facility management staff and acquisitions staff.*

-   *Include nursing assistants on the implementation team. This
    increases the involvement and ownership among nursing assistants,
    who are the staff that will utilize the hip protectors the most.*

-   *Provide management with regular updates on the program and the
    reduction of fall injury rates. This increases the likelihood that
    they will provide the support needed for hip protectors.*

-   *Providing updates to VA Directors meetings increases the likelihood
    that management will support the project.*

# Video 3: Protecting Your Hips with Hip Protectors

The video *Protecting Your Hips with Hip Protectors* is designed to
inform patients about hip protectors and to help caregivers convince
patients to wear the hip protectors. A copy of the video should be given
to patients who are provided with hip protectors or to patients whom
caregivers believe should be wearing hip protectors. The video can also
help educate families about the importance of hip protectors. This video
can be used as part of an information package for caregivers including
pamphlets and flyers.

*Audience*: Outpatients who are starting to use hip protectors or who
caregivers think should wear hip protectors, and families of patients
who are or should be wearing hip protectors.

*Materials Needed*: Hip Protectors brochure

*Supplemental Materials*: Fall Prevention at Home brochure