Implementation and evaluation of a nursing home fall management program.
OBJECTIVE
To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs).


METHODS
A quality improvement project with data collection throughout FMP implementation.


METHODS
NHs in Georgia owned and operated by a single nonprofit organization.


METHODS
All residents of participating NHs.


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Rask
Kimberly
K
Center on Health Outcomes and Quality, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. krask@emory.edu
Parmelee
Patricia A
PA
Taylor
Jo A
JA
Green
Diane
D
Brown
Holly
H
Hawley
Jonathan
J
Schild
Laura
L
Strothers
Harry S
HS
Ouslander
Joseph G
JG
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005845:Georgia; D006284:Health Plan Implementation; D006707:Homes for the Aged / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012307:Risk Factors; D017751:Safety Management / Q000458:organization & administration*