Georgia Long-Term Care Organization Implements AHRQ-Funded Falls Management Program
Ethica Health and Retirement Communities (Ethica), a long-term care organization with health care and living centers throughout Georgia, has implemented a program developed by AHRQ under a contract with the Center for Health in Aging at Emory University. The program is designed to manage falls and reduce the severity of injuries from falls. Ethica provides clinical consultation to 49 nursing homes and 4 assisted-living facilities that provide care and services to nearly 5,000 patients and residents in 38 Georgia counties.
Before 2006, Ethica used routine safety procedures to prevent residents from falling. However, after Ethica officials were contacted by Emory University researchers, they were eager to participate in developing an evidenced-based falls management program (FMP). The FMP includes a set of tools and processes intended to guide screening and assessment, response to falls, and collection and analysis of falls-relevant data for use in quality improvement. The FMP is designed to reduce the risk of residents' falling and to address environmental and equipment hazards.
Jo A. Taylor, RN, a colleague of Joseph G. Ouslander, MD, Director of the Center for Health in Aging at Emory University, assembled a team of trainers from Emory to initiate the training program. Ethica regional nurses were trained using a "train-the-trainer" approach. Falls Management Coordinators of the initial Ethica sites also received FMP training.
Nursing centers were asked to select an interdisciplinary falls team including a physical or occupational therapist, two to four certified nursing assistants, a member of the maintenance staff to serve as the "falls engineer," and the director of nursing. The falls engineer is responsible for safety inspection of equipment and facility space inspection. The falls coordinator serves as the leader of the team within each facility.
Together with Lucy Rogers, president at Ethica, the trained staff helped to create a culture to encourage staff buy-in, starting with administrators at centers with a stable and seasoned staff. This approach has paid off by winning the support of program "champions"-administrators, managers, or staff members in each of the centers who keep teams motivated.
The core group of each falls team attends centralized training, receives education on team dynamics, and attends weekly meetings to discuss the falls program and individual residents. If a resident falls, the staff on duty assess the reason for the fall and implement interventions to decrease the risk for other falls. The case of each resident who falls is reviewed by the falls management team at their next meeting.
Care planning involves families, along with the falls team, in the comprehensive falls prevention program. "The main question is, 'What can we do to keep our residents safe?'" says the vice president of clinical services, Lisa Burk. Safety measures used to reduce the risk of falls include appropriate footwear; devices that make daily activities less risky; reminders to ask for assistance; medication adjustments; monitoring for low blood pressure; protective aids such as hip, elbow, or knee pads; beds that are low to the floor; and soft helmets, depending on resident cognitive level and physical functioning.
As new patients are admitted, staff conduct a routine, thorough evaluation and assessment, screening each resident for their risk of falling-analyzing the patients themselves, their medications, their equipment, and the environment. Those at risk of falling are placed in the falls management program.
The FMP was instituted at the same time as the State- and corporate-wide initiatives to reduce physical restraint use occurred. Previous company data from January 2004 showed that 8 percent of Ethica residents were restrained in order to keep them safe and that 20 percent of residents had experienced falls. Following restraint reduction efforts, Ethica reported that 2 percent of its residents were restrained, and 17 percent had experienced falls in September 2007 at participating sites. This may indicate that the FMP was able to prevent an increase in falls that would have followed from restraint reduction.
AHRQ-funded research has shown that implementation of the program is feasible, improves care process documentation, and may reduce falls even in the face of substantial reduction in the use of restraints, a major emphasis of the Federal Government. Ouslander's work also addressed several factors that can play an important role in medical errors and resident injuries in long-term care facilities, including the following:
- Lack of education among staff and primary care providers on risk factors for patient injuries.
- Lack of effective tools that facilitate documentation and communication.
- Sub-optimal use of information systems.
Taylor JA, Parmelee P, Brown H, Strothers HS, Capezuti E, Ouslander JG. A model quality improvement program for the management of falls in nursing homes. Journal of the American Medical Director's Association March 2007; 8(3 Suppl):S26-36. (HS11588)