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Implementation and Evaluation of a Nursing Home Fall Management Program
Author(s) -
Rask Kimberly,
Parmelee Patricia A.,
Taylor Jo A.,
Green Diane,
Brown Holly,
Hawley Jonathan,
Schild Laura,
Strothers Harry S.,
Ouslander Joseph G.
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01083.x
Subject(s) - medicine , audit , quality management , documentation , nursing , intervention (counseling) , fall prevention , family medicine , medical emergency , poison control , operations management , suicide prevention , management system , management , computer science , economics , programming language
OBJECTIVES: To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs). DESIGN: A quality improvement project with data collection throughout FMP implementation. SETTING: NHs in Georgia owned and operated by a single nonprofit organization. PARTICIPANTS: All residents of participating NHs. INTERVENTION: A convenience sample of 19 NHs implemented the FMP. The FMP is a multifaceted quality improvement and culture change intervention. Key components included organizational leadership buy‐in and support, a designated facility‐based falls coordinator and interdisciplinary team, intensive education and training, and ongoing consultation and oversight by advanced practice nurses with expertise in falls management. MEASUREMENTS: Process‐of‐care documentation using a detailed 24‐item audit tool and fall and physical restraint use rates derived from quality improvement software currently used in all Georgia NHs (MyInnerView). RESULTS: Care process documentation related to the assessment and management of fall risk improved significantly during implementation of the FMP. Restraint use decreased substantially during the project period, from 7.9% to 4.4% in the intervention NHs (a relative reduction of 44%), and decreased in the nonintervention NHs from 7.0% to 4.9% (a relative reduction of 30%). Fall rates remained stable in the intervention NHs (17.3 falls/100 residents per month at start and 16.4 falls/100 residents per month at end), whereas fall rates increased 26% in the NHs not implementing the FMP (from 15.0 falls/100 residents/per month to 18.9 falls/100 residents per month). CONCLUSION: Implementation was associated with significantly improved care process documentation and a stable fall rate during a period of substantial reduction in the use of physical restraints. In contrast, fall rates increased in NHs owned by the same organization that did not implement the FMP. The FMP may be a helpful tool for NHs to manage fall risk while attempting to reduce physical restraint use in response to the Centers for Medicare and Medicaid Services quality initiatives.