Harmony Healthcare Blog

Quality Measure #8: One or More Falls with Major Injury - Long Stay (Part 2)

Posted by Kathy Monahan on Tue, Oct 11, 2016

Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

5 Steps to Develop a Fall Prevention Process 

plainfield-nursing-home-falls-lawyer.jpgIn Part 1 of our Quality Measure #8 series, Harmony Healthcare International (HHI) discussed the Quality Measure Item Sets for triggering one or more falls with major injury.  After identifying a resident that has triggered for this quality measure, what is the next step? The Harmony HealthCARE Specialists work alongside their clients to identify the clients at risk, as well as assist in strengthening the Development of a Fall Prevention Process.  

  1. Clinical Focus: Prevent Falls
    • Falls are a leading cause of morbidity and mortality among nursing home residents.
    • Falls result in serious injury, especially hip fractures.
    • Previous falls, especially recurrent falls and falls with injury, are the most important predictor of future falls and injurious falls. 
  1. Clinical Management Strategies:
    • Review falls assessment outcomes and develop protocols. Some questions to consider in developing an assessment process are:
      • Who assesses the resident upon admission to determine risk of falling?
        • First and foremost is to have clear and consistent communication between nursing assistants and licensed nurses about which residents are at risk for falls. Any resident who has a pattern of falls is at risk of falling again. After the licensed nurse has assessed a resident for a fall risk it is important to communicate the results of the assessment to the nurse's front-line coworkers. Nursing assistants are better equipped to guard against falls when they know which residents—especially new residents or those in transition back from hospital stays—are going to need a special "fall watch."
      • When are the residents assessed? Some standardized assessments used by both nursing and therapy include: 
        • The 30-Second Chair Stand Test
        • The Timed Up and Go (TUG) Test
        • The 4-Stage Balance Test
        • Orthostatic Blood Pressure
        • Allen Cognitive Screen
      • How are the results communicated to the staff?
      • How are the results used to develop a fall program for the resident?
      • Which patients should have a fall program?
      • What interventions will be utilized when a resident falls? 

  1. Root Cause Analysis
    • Traditional Models of looking at adverse events have focused on holding an individual Root Cause Analysis (RCA) guides you to look at systems and what made it possible for the adverse event to happen:
      • Gather and Document Initial Information
      • Interview staff and others closely involved
      • What do you think happened?
      • Use open ended questions, “Tell me about… 
  1. Establish a Falls Management team that meets regularly to discuss falls and perform Root Cause Analysis to identify causes and trends in the facility that contributes to falls. Who should be a part of the process?
    • CNAs: Why CNAs? They spend more time with patients than anyone else, they know more about the patients than you think.  Including CNAs on the falls team is empowering to the aides and will empower them to report problems and suggest solutions.
    • Administration: The administrator supports the program and the team.  He or she filters down the importance of the program and shares information with the team. 
    • Nursing: Responsible for patient assessment, care planning, medication management and follow through with falls prevention strategies. 
    • Rehabilitation: Responsible for Patient Assessment, screening, treatment, sensory system assessment (vision and balance), environmental assessment, proper footwear, care planning and follow through of interventions. 
    • Activities: Responsible for Patient Assessment, providing meaningful diversional activities, assists with identification of falls trends and solutions, providing exercise classes.
    • Dietary: Patient assessments, identify patients at risk for fractures, maintenance of strong bones through diet and identify patients at risk for dehydration. 
    • Housekeeping: Environmental hazards, placement of furniture, location of bed linens.
    • Maintenance: Environmental hazards, lighting, environmental aids, preventative maintenance program for beds, wheelchairs, and walking aids. 
  1. Care Planning and QAPI
    • Facilities should examine their current care planning process for falls. This would also make an excellent Continuous Quality Improvement (CQI) project or Performance Improvement Project (PIP) for the Quality Assurance team. Outcomes of the CQI/PIP could include identifying falls risks and trends and reducing falls in the facility. 

Harmony Healthcare International (HHI) is available to provide ongoing education and training to the facility leadership to develop a proactive care planning process and Falls Management team to improve quality assurance reporting and further auditing and monitoring of the Injurious Falls Quality Measure. Please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413. 


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Tags: Quality Measures, falls, Injurious Fall

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