Roadmap Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care SectionAction StepsTool That Supports ActionWho Should Use The ToolOverviewEnlist support of senior leadersWord Version [ - 30.6 KB];Senior managerSection 1Are you ready for this change?1.1Assess the culture of safety in your hospitalTool 1A, Hospital Survey on Patient Safety Culture;Word Version [ - 49.85 KB]All interdisciplinary team members1.2Evaluate current organizational attention to fallsTool 1B, Stakeholder Analysis; Word Version [ - 30.26 KB]Implementation Team leader1.3Assess and develop leadership support for the fall prevention programTool 1C, Leadership Support Assessment; Word Version [ - 29.62 KB]Tool 1D, Business Case Form; Word Version [ - 29.16 KB]Implementation Team leader1.5Identify resources that are available and resources that are neededTool 1E, Resource Needs Assessment; Word Version [ - 28.99 KB]Implementation Team leader1.7Assess your progress on completing readiness for change activitiesTool 1F, Organizational Readiness Checklist; Word Version [ - 29.55 KB]Implementation Team leaderSection 2How will you manage change?2.1Identify your Implementation TeamTool 2A, Interdisciplinary Team; Word Version [ - 40.94 KB]Implementation Team leader2.2Assess the current status of fall prevention activities in your hospitalTool 2B, Quality Improvement Process; Word Version [ - 30.48 KB]Tool 2C, Current Process Analysis; Word Version [ - 30.33 KB]Tool 2D, Assessing Current Fall Prevention Policies and Practices; Word Version [ - 33.9 KB]Implementation Team leader, individuals designated by the Implementation Team leaderDetermine staff knowledge about fall preventionTool 2E, Fall Knowledge Test; Word Version [ - 32.79 KB]Staff nurses and nursing assistants2.3Set goals for improvement based on outcomes and processesTool 2F, Action Plan; Word Version [ - 34.66 KB]Implementation Team leader with quality improvement/safety/risk manager2.4Assess your progress on completing the managing change activitiesTool 2G, Managing Change Checklist; Word Version [ - 29.25 KB]Implementation Team leaderSection 3Which fall prevention practices do you want to use?3.1Identify how fall prevention care processes connect to one anotherTool 3A, Master Clinical Pathway for Inpatient Falls; Word Version [ - 61.8 KB]Quality improvement/safety/risk manager, staff nurses, nursing assistants3.2Implement universal fall precautionsTool 3B, Scheduled Rounding Protocol; Word Version [ - 29.92 KB]Tool 3C, Tool Covering Environmental Safety at the Bedside; Word Version [ - 36.01 KB]Tool 3D, Hazard Report Form; Word Version [ - 30.13 KB]Tool 3E, Clinical Pathway for Safe Patient Handling; Word Version [ - 61.22 KB]Unit manager, staff nurses, nursing assistants, facility engineer, hospital employee who enters patient rooms3.3Identify important risk factors for falls in your patientsTool 3F, Orthostatic Vital Sign Measurement; Word Version [ - 32.37 KB]Tool 3G, STRATIFY Scale for Identifying Fall Risk Factors;Tool 3H, Morse Fall Scale for Identifying Fall Risk Factors; Tool 3I, Medication Fall Risk Score and Evaluation Tools; Staff nurses, pharmacist, nursing assistants3.4Use identified fall risk factors to implement fall prevention care planningTool 3J, Delirium Evaluation Bundle: Digit Span, Short Portable Mental Status Questionnaire, and Confusion Assessment Method;Tool 3K, Algorithm for Mobilizing Patients; Word Version [ - 96.08 KB]Tool 3L, Patient and Family Education; Word Version [ - 29.6 KB]Tool 3M, Sample Care Plan; Word Version [ - 32.47 KB]Educators, staff nurses, physicians, nurse practitioners, physician assistants, nursing assistants3.5Assess and manage patients after a fallTool 3N, Postfall Assessment, Clinical Review; Word Version [ - 33.64 KB]Tool 3O, Postfall Assessment for Root Cause Analysis; Word Version [ - 43.48 KB]Staff nurses and physicians3.8Assess your progress on completing the best practices activitiesTool 3P, Best Practices Checklist; Word Version [ - 29.23 KB]Implementation Team LeaderSection 4How do you implement the fall prevention program in your organization?4.1Assign staff roles and responsibilities for tasks identified in set of best practicesTool 4A, Assigning Responsibilities for Using Best Practices; Word Version [ - 29.14 KB]Tool 4B, Staff Roles; Word Version [ - 31 KB]Implementation Team Leader, Unit manager4.3Assess current staff education practices and facilitate integration of new knowledge on fall prevention into existing or new practicesTool 4C, Assessing Staff Education and Training; Word Version [ - 30.88 KB]Implementation Team Leader4.4Assess your progress on implementing best practices activitiesTool 4D, Implementing Best Practices Checklist; Word Version [ - 29.22 KB]Implementation Team LeaderSection 5How do you measure fall rates and fall prevention practices?5.1Collect the right data to learn about falls, fall-related injuries, and their causesTool 5A, Information To Include in Incident Reports; Word Version [ - 30.61 KB]Quality improvement/risk manager, information systems staff5.2Measure fall prevention practicesTool 5B, Assessing Fall Prevention Care Processes; Word Version [ - 41.74 KB]Unit manager and unit champions5.3Assess your progress on measuring progress activitiesTool 5C, Measuring Progress Checklist; Word Version [ - 29 KB]Implementation Team LeaderSection 6How do you sustain an effective fall prevention program?6.3Identify factors need to sustain your fall prevention effortsTool 6A, Sustainability Tool; Word Version [ - 32.85 KB]Implementation Team Leader Current as of January 2013 Internet Citation: Roadmap: Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallpxtoolkit/fallpxtkmap.html
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