AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention
On-Time Falls Prevention was developed to provide the multidisciplinary nursing home team with electronic medical record (EMR)-based tools to effectively monitor resident fall risk and implement proactive strategies to prevent falls. The tools include four reports produced monthly that are populated with clinical information from the EMR.
Clinical reports provide resident and fall risk information staff need to proactively implement care plan interventions aimed at preventing falls. Reports also provide the facility team with information to assist them in analyzing resident fall risks, falls that have occurred, and postfall assessments that have been conducted as part of their quality improvement (QI) programs. Some of these reports provide facility- or unit-level information that leadership may use to monitor trends in factors frequently leading to falls.
On-Time Falls Prevention has been developed with input from clinical and research experts and the feedback of nursing home clinicians who reviewed and tested the feasibility of the risk rules and provided input on information for inclusion in reports and their formatting. A review of literature and existing clinical resources aimed at preventing falls in nursing homes also informed the development of On-Time Falls Prevention.
A sample report is shown for each report, but the exact presentation of a report will depend on the EMR vendor that produces the report. The purpose of showing the sample reports is to give nursing home staff a sense of the type of information included in the reports. Functional specifications are provided to the vendor so that reports can be programmed correctly.
Each report is described in detail in the Electronic Reports section. Details of the reports are discussed as part of the training for On-Time facilitators when a nursing home decides to implement this module.
In addition to the four electronic reports, implementation tools are provided to help staff decide which reports they want to use and in which meetings or huddles they will use the reports. All implementation materials are intended to be used by staff with the help of a trained facilitator.
Implementation materials include the Falls Prevention Self-Assessment Worksheetl, which guides staff in a review of current practices for recognizing residents at high risk for falls. The self-assessment will help facilities planning to implement On-Time Fall Prevention to identify areas with potential for improvement as they work toward On-Time implementation.
A menu of implementation strategies is another component of the On-Time program’s implementation materials. The implementation strategies menu offers a set of choices for reviewing report information in existing or new meetings or huddles and suggests attendees for these meetings. Providing a variety of strategies for using one report or a combination of reports allows the facility team to consider alternative uses that may fit within its current workflow and meet the unique needs of their facility, avoiding a “one size fits all” approach. Table 1 lists reports and implementation materials for falls prevention.
As with all On-Time reports, the On-Time Falls Prevention reports and implementation materials are designed to be implemented by a nursing home change team with the help of an On-Time facilitator who helps the team understand and use the reports and integrate the reports into day-to-day practice. A training curriculum for facilitators has been developed and is an available On-Time resource.
Table 1. On-Time Falls Prevention: Reports and Implementation Materials
|Falls High-Risk Report|
|Summary of Fall Risk Factors (by Unit or Facility, quarterly or monthly)|
|Contextual Factors Report (by Unit or Facility, quarterly or monthly)|
|Postfall Assessment Summary Report (by Resident)|
|Fall Prevention Self-Assessment Worksheet|
|Menu of Implementation Strategies|
|Implementation Steps and Timeline|
- Self-Assessment Worksheet for Falls Prevention.
- Falls Prevention Menu of Implementation Strategies.
- Implementation Steps and Timeline.