Improving nursing home falls management program by enhancing standard of care with collaborative care multi-interventional protocol focused on fall prevention

Abstract

Purpose: The objective of this quality assurance project was to implement a collaborative multi-strategy fall risk management program to reduce patient falls within a nursing home. Design: A quasi-experimental study. Intervention: A multi-interventional program based on recommendations from Agency for Healthcare Quality was instituted. Direct care providers were required to conduct every 2-hour rounding on patients. The staff was required to participate in organizational education and training on fall prevention strategies. Patients were encouraged to participate in activities outside of their rooms throughout the day. Monthly meetings were held to review fall occurrences, collaborate on project initiatives, and discuss trends in fall rates. Setting and Sample: The setting for this project was a 150-bed nursing home in suburban Texas. A total of 10 participants were recruited for the fall team, and interventions were performed on each of three nursing units. The median age of the patient population was 75 years old of which 46% are males, and 53% are females. Measurement: The Falls Management Program-How to Reduce Fall questionnaire was completed before and after the intervention period to evaluate participants' knowledge about falls and prevention. Quality assurance data were reviewed, analysis of documentation for rounding, activities, and falls data was completed. Results: The pre-implementation mean fall rate per month was 24.5 (average monthly census was 120 patients), compared to 2-month and 4-month post-implementation mean rates which were 13.5 (average monthly census was 116 patients), and 9.5 (average monthly census was 111 patients). A knowledge test "How to Reduce Falls" was administered to the fall team. Average scores were proportionately better on the 4-month Post-test (2-month Post-test: p = .037), and (4-month Post-test: p = .029). Additionally, statistical results indicate there is a significant difference in falls rate comparing pre-implementation to 4-month post-implementation (t(2) = 25.981, p < .05). Discussion: Implementation of best quality fall prevention programs can improve the overall health and quality of life of patients. Care providers must be vigilant in consistently facilitating evidence-based practices that contribute to best outcomes for every patient. In so doing, enhanced standards of care will circumvent patient falls and promote best patient outcomes.