A Flowchart System to Improve Fall Data Documentation in a Long-Term Care Institution: A Pilot Study

Abstract

Falls are an important cause of morbidity and mortality in older people. In many long-term care (LTC) institutions, current practice focuses only on the injury consequences with a lack in the assessment of main risk factors, characteristics of the fall episode, and secondary prevention. To document current practice in our center and to determine whether implementation of a flowchart system may improve fall data documentation. A flowchart system with an ad hoc form was designed to advise on falls characteristics, post-fall risk factors identification, and appropriate referral. Educational sessions explaining the rationale for the flowchart system were given before the implementation of the system. An audit was conducted on incident report data in order to register the fall data documentation in our facility. The audit was repeated 2 months after implementation of the flowchart system. There were 107 incident reports audited before and after the implementation of the flowchart system. Seven observations were excluded. Average age of the participants with falls was 82.7 (SD: 3) and 53% of the participants had dementia. Comparisons between the first and second audit revealed significance differences in the history of previous falls (95% vs 35%, P < .001), the place of fall (89% vs 32%, P < .002). After the implementation new information not previously gathered, such as polypharmacy prevalence, use of benzodiazepines and psychotropic medication, and potential etiologies and contributors of the falls episodes were obtained. After the introduction of the flowchart system, documentation of risk factors and characteristics of fall episodes have improved significantly and referrals to a geriatrician for falls evaluation have significantly increased. The process of education and implementation of a flowchart system with an ad hoc form improved data documentation performed following a fall. This simple strategy could help the development of falls prevention program in the nursing home.