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Reducing Falls Takes Teamwork

April 1, 2004
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A Cincinnati LTC organization develops its own interdisciplinary approach to reduce falls by Ronda Christopher, MEd, OTR/L, LNHA

Reducing falls takes teamwork

An interdisciplinary approach has been the key to success for this fall prevention program Fall prevention is obviously important in terms of long-term care residents' safety and well-being, but how does fall prevention-or the lack thereof-affect a facility's well being? Every long-term care administrator and staff member should know the answer to that question. Because fall rates are closely scrutinized by government agencies, third-party payers, and consumers-and also are recognized as a measure of quality care-fall prevention is vital to facilities' performance and to public perception about their performance.

Proactively addressing this issue will help ensure that quality care is not only a concept, but a reality-one that regulatory agencies and consumers will note. Furthermore, paying adequate attention to or, conversely, neglecting this important area of quality care can certainly affect the bottom line. Treating injuries that result from falls is an avoidable expense-something no facility wants or needs in these days of limited reimbursement and rising costs. And statistics suggest that treating fall-related injuries will cost significantly more over the next several years.1

The Senior Health and Housing Services (SHHS) Division of Mercy Health Partners (MHP) in Cincinnati, consisting of Mercy Franciscan West Park, Mercy Franciscan Terrace, Mercy Franciscan Schroder, and Mercy St. Theresa Center, formed a collaborative oversight team called the Quality and Resident Safety Committee to address the organization's growing concern regarding its facilities' fall rates. The administrators, medical director, and directors of nursing from the four buildings agreed that a committee was needed to focus on reducing each facility's fall rate and thus improving quality of care.

The main objectives of the fall prevention initiative were to encourage an interdisciplinary approach to problem solving, reduce the potential for risk and injury to residents, provide the best prospect for positive survey results, and create an opportunity to improve consumer perception about our facilities. These objectives continue to be the committee's focus.

Understanding that successful implementation would require that the committee be truly interdisciplinary, members included risk management staff, the medical director, the director of nursing and quality nurse representative (for each building), and representatives from dietary and therapy services.

When the committee was formed, Mercy Franciscan Schroder had the lowest rate of falls of the four buildings. Schroder had already carefully examined its fall rates, using an interdisciplinary approach and the following processes: tracking and trending causes, going restraint-free while investing in appropriate equipment to ensure safety; conducting continuous in-services on transfers and lifts; increasing referrals to restorative and rehabilitation services; and having restorative services act as the gatekeeper of the falls investigation protocol.

When Schroder started looking at its fall prevention in July of 1999, its new DON took an aggressive approach to address the issue, realizing that: (1) residents needed to be active and (2) residents did not have what they needed to remain active. It was decided that Schroder would be a restraint-free environment and that every department-including housekeeping, dietary, and maintenance-would be responsible for keeping the environment restraint-free.

With that focus in mind, every resident who was considered a fall risk was assessed to determine whether the risk arose from extrinsic factors (i.e., environmental set-up) or intrinsic factors (i.e., disease process, weakness, pharmacologic contraindications, etc.). Once the cause of the fall risk was determined, a plan of care was implemented.

For those residents at extrinsic risk, a review of the environment was completed by all departments, and changes were made. For example, a bolster, floor mat, or trapeze would be put in place, or the room would be arranged, according to the resident's need. For those at intrinsic risk, the interdisciplinary team assessed what the cause might be and then made appropriate changes. Those might include a bowel and bladder program to reduce a resident's urgency to get out of bed; a referral to restorative or therapy for strength training or balance assessment; or increasing the resident's participation in activities (including one-on-one activities).

Two critical factors were necessary for the program to succeed: a continual review of the plan of care for each resident approximately every three days until resident falls ceased, with quick changes made to the plan of care as needed, and a commitment from all staff, in every department, that a reduction in falls was not just a theory but was to be a reality.

Because Schroder's comprehensive approach had produced excellent outcomes, the committee chose to mimic that facility's processes. The committee projected a per-bed, per-year goal of 1.5 falls as an internal benchmark for measuring success and adopted the following measures as means of reaching the goal:
  • Create a committee committed to using a structured problem-solving methodology, and tools to analyze quality indicator data and identify and implement viable solutions
  • Reduce falls by seeking and sharing best practices related to fall prevention across the four facilities and other LTC providers