Reduction In Fall Rate Research Articles

Views and experiences of older people taking part in a safe-falling training program: Lessons learned from the FAlling Safely Training (FAST) trial

BackgroundWhile falls are the leading cause of accidental injury among older people, the current fall prevention strategies have not resulted in a remarkable reduction in fall rates. An alternative novel approach, teaching older adults how to fall safely to prevent injury, has been recently implemented in the FAlling Safely Training (FAST) trial. The current study aimed to explore the views and perceptions of older people about their participation in the safe-falling training program.MethodsFocus groups were conducted with eight community-dwelling older adults (age range: 66 to 76 years, five females) at risk of falling who completed the FAST program. Two focus groups involving four participants each were conducted. Recordings were transcribed verbatim and analyzed using thematic analysis.ResultsThree themes were identified following the analysis: (1) Before the training; with subthemes: Previous fall prevention strategies and Motivation to participate. Motivations to take part in the training included worries about falling, an awareness of an increased risk of falling, and a desire to decrease the chances of sustaining an injury. (2) Training itself; with subthemes: General impressions of the training and Learning the techniques. Older people highlighted that the training was well-designed and executed. (3) Going forward; with subthemes: Training increased confidence, Incorporating in a community setting, and Proposing improvements to the study. It was reported that the training enhanced participants’ confidence about falling without injury. Incorporating the training into a community context was discussed, and suggestions for program enhancements were made. The individual nature of the training was valued, but participants also provided suggestions for how they would see the program taking place successfully in small groups.ConclusionsThe results indicated that the safe-falling training was acceptable to older adults. The perceived ability to fall without injury was reported to have increased. Individuals who experienced a fall after the training ended reported being able to use the techniques learned in their daily life. The findings have implications for the training to be refined and implemented in the community.Trial registrationThe article is linked to a randomized controlled trial registered at http://ClinicalTrials.gov (NCT05260034).

Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility.

Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs. A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods. Clinical (life-sustaining treatment, falls, disruptive behaviors, and medication deprescribing) and quality outcomes (rehospitalization, emergency department utilization, and discharge to the community) in addition to patient satisfaction were compared pre- and post-AFHS implementation (bed days of care [BDOC] 17413) to post-implementation (BDOC 20880). Clinical outcomes demonstrated improvements in the 4Ms, including: (1) what matters: 14% increase in life-sustaining treatment documentation (82%-96%; p < 0.01); (2) mobility: reduction in fall rate by 34% (8.15 falls/1000 BDOC to 5.41; p < 0.01); (3) mentation: decrease in disruptive behavior reporting system (DBRS) by 62% (5.11 DBRS/1000 BDOC to 1.96; p = 0.04); (4) medications: 53% increase in average potentially inappropriate medications (PIMs) deprescribing (0.38-0.80 interventions/patient; p < 0.01). Quality outcomes improved including rehospitalization (25.6%-17.9%) and emergency department utilization (5.3%-2.8%) within 30 days of admission. Patient satisfaction scores improved from a mean of 77.2 (n = 31, scale 1-100) to 81.3 (n = 42). Implementation of the AFHS initiative in a SNF was associated with improved clinical and quality outcomes and patient satisfaction. We describe here a sustainable, interprofessional approach to implementing the AFHS in a SNF.

Impact of Timely Assessment for Risk of Fall by Using Morse Scale in Adult Medical &amp; Surgical Unit of Tertiary Care Hospital in Pakistan

Background: Patient falls in healthcare settings are a significant concern, impacting patient safety and healthcare outcomes. The Morse Fall Scale (MFS) has been widely recognized as an effective tool for assessing fall risk among hospitalized patients. Despite its widespread use, there is a need for a comprehensive evaluation of its effectiveness, implementation challenges, and the perceptions of healthcare staff towards its utility. Objective: This study aims to evaluate the effectiveness of the MFS in reducing patient falls in a tertiary care hospital and to assess healthcare staff's perceptions regarding its usability and impact on patient care. Methods: A retrospective data analysis was conducted, examining fall events from July 2020 to December 2020, before the implementation of the MFS, and from January 2021 to May 2021, after its implementation. The study included all adult patients admitted to the medical and surgical units, excluding those from ambulatory care units and the emergency department. Staff perceptions were gauged through a survey assessing the ease of use, time efficiency, and effectiveness of the MFS in identifying high-risk patients. Data analysis utilized SPSS version 25 for statistical evaluation. Results: The implementation of the MFS was associated with a significant reduction in fall rates, from a total of 9 falls in the six months prior to implementation to zero falls in the five months post-implementation. Survey results indicated that 89% of nurses found the MFS quick and easy to use, 63% reported that it took less than 3 minutes to complete an assessment, 98% found the scale easy to understand, 95% stated it helped identify high-risk patients, and 97% felt comfortable tailoring interventions based on the MFS scores. Conclusion: The MFS effectively reduced fall rates in the hospital setting, with healthcare staff affirming its ease of use and effectiveness in identifying at-risk patients. These findings support the continued use and further refinement of the MFS as a critical component of patient safety strategies.

93 Reduce falls rates in care homes by replacing falls risk screening with a Multifactorial Falls Risk Assessment Tool

Abstract Background Following a review (Nov 2022) of 203 residents across four locations, it was noted that falls risk screening tools were used to identify falls risk status. This resulted in a proportion of residents identified as low (5%) and medium risk (28%). New falls prevention guidelines incorporating care homes, recommend against falls risk screening (Montero-Odassa et al, 2022). The guidelines recommend that all residents in care homes should be considered at high risk of falls and use of a Multifactorial Falls Risk Assessment Tool (MFRAT) is preferable in falls prevention. Our aim is a reduction in falls rate by discontinuing the use of falls risk screening tools and implementing a MFRAT. Embed this change within a new standardised falls policy and deliver staff education sessions to support this change. Methods Stakeholder engagement and development of a falls committee with seven representatives across each location including nursing, management, quality and patient safety advisor and falls coordinator was undertaken. Communication strategy of weekly online meetings developed a standardised falls policy, tailored MFRAT and audit tool to monitor compliance. Reported falls were cross referenced with our national incident management system. Falls rate calculation across each location was used to measure the impact of change. Results Results demonstrated a 29% reduction in falls rate for the first quarter of 2023, compared to 2022. 100% compliance with policy implementation across all locations, with 68% of staff trained through education sessions face to face and online. Conclusion Implementing a MFRAT, aligned with new world guidelines, supported by staff education, and associated falls prevention interventions provides a reduction in fall rates in care home residents. The process of falls rate calculation across locations provides ease of evaluation.

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework.

Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.

Sleep protocol-Use of evidence-based practice (EBP) to improve patient outcomes and patient satisfaction while hospitalized.

Anecdotal observation at a 55-bed training hospital indicated decreased patient satisfaction from patients not feeling rested during hospitalization related to staggered nighttime nursing care. The main aim of this study is to implement a new culture of patient centeredness to enhance patient care and improve outcomes at a 34-bed Medical-Surgical Inpatient Unit (MSIU) within the training hospital. An evidence-based practice approach was chosen to address the aim. This included the development of a PICOT (population, intervention, comparison, outcome, and time frame) question, a systematic search of the literature, a critical appraisal of the evidence, implementation of the intervention, evaluation of outcomes, and dissemination of the results. Twenty-three articles were critically appraised, resulting in 11 keeper articles. The body of evidence reviewed demonstrated that minimizing nighttime patient interruptions through bundled care could improve patient sleep, pain perception, and patient outcomes and reduce fatigue. Bundled care was implemented in the MSIU for 1year. During this year, there was a significant reduction in hydrocodone administration, a notable reduction in prescription sleep aid administration, a 75% reduction in fall rates, a cost savings of $64,000, and a decrease in patient length of stay. Allowing patients to rest could have benefits. Rest improves outcomes, length of stay, satisfaction scores, and fall rates and reduces the need for medications. Clustering care allows patients to receive uninterrupted rest.

Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation

ObjectivesTo determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes.DesignMulticentre, parallel, cluster randomised controlled trial.SettingLong term care homes...

PUP® (Patient Is Up) Smart Sock Technology Prevents Falls Among Hospital Patients With High Fall Risk in a Clinical Trial and Observational Study.

Hospital inpatient falls, especially of older adult patients, can result in injury and death and generate high costs. A new technology, PUP® (Patient Is Up) Smart Socks, combines sensors and geolocation in socks with a wireless platform. To determine whether these socks prevent falls of patients with high fall risk, we performed a clinical trial at one hospital, and an observational study at two other hospitals. In the clinical trial, patients spent 1,694 patient-days wearing the socks, reducing falls from 4 to 0 per 1,000 patient-days (p < 0.01). In the observational study, patients spent 2,286 patient-days wearing the socks, reducing falls from 4 to 1.3 per 1,000 patient-days (p < 0.05). The new technology resulted in a significant reduction in fall rates among patients with high fall risk and may greatly reduce inpatient fall-related injury and death and their associated costs. [Journal of Gerontological Nursing, 47(10), 37-43.].

Fall prevention education for people with multiple sclerosis: a randomized clinical trial.

Online spaced education (OSE) is a method recognized for promoting long-term knowledge retention, changing behaviors and improving outcomes for students and healthcare professionals. However, there is little evidence about its impacts on patient education. The aim of this research was to compare knowledge retention using educational brochure and OSE on individuals with multiple sclerosis (MS) and to verify the impact of educational methods on fall outcome. Individuals with MS (n = 230) were randomly assigned to two types of patient education-educational brochure (control) and OSE (intervention). During 12 weeks, the intervention group received multiple-choice tests on fall prevention. Knowledge retention, behavior change and fall incidence were assessed before intervention and after 3 and 6months. The participants' satisfaction with the education method was also evaluated. Knowledge retention was similar between groups, and behavior change was observed in both groups. There was a significant reduction in fall rate in the intervention group, from 0.60 to 0.27 at 6months (P < 0.001). Participants' satisfaction achieved an average of 8.75, with no differences between groups. Individuals demonstrated significant improvement in fall rate outcome in both groups with no significant difference. In regard to test scores and satisfaction, results were similar between groups.

EFFECTIVENESS OF EDUCATIONAL INTERVENTIONS FOR FALL PREVENTION: A SYSTEMATIC REVIEW

ABSTRACT Objective: to assess the effectiveness of educational interventions for fall prevention implemented in hospitals, at homes and nursing homes. Method: this is a systematic review, carried out based on the guiding question: what is the effectiveness of isolated educational interventions for preventing falls in adults and the elderly developed in experimental studies? The search took place in the electronic databases: Scopus, PubMed/PMC, Web of Science, CINAHL, SciELO, Cochrane and EMBASE. The exposure factor was the educational intervention on preventing falls, and as outcomes: reducing fall rates, improving knowledge, awareness and adherence to preventive care for adult and elderly patients. Only randomized controlled trials, in all languages and published between 2011 and 2020 were included. Results: 1,474 articles were identified, of which 16 were included. Four studies did not show effectiveness related to fall prevention. As common characteristics, these studies were carried out with elderly patients and without one-to-one follow-up. The others were effective in reducing falls and/or improving knowledge and were mostly studies with personalized interventions, carried out by nurses and mediated by educational technologies. Conclusion: educational interventions are effective for preventing falls in the home, hospital and nursing homes. Studies have shown a reduction in fall rates, improved knowledge and engagement in prevention strategies.

Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial.

The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI. RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life. Participants' average age was 82 years (95% CI 82-83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37-0.98). There were no significant between-group differences for other secondary outcomes. This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function. Australian and New Zealand Trials Registry ACTRN12614000603617.

Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review.

Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions. To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting. All adult patients admitted to medical or surgical acute care units for any condition or illness. Patient-centered intervention strategies to reduce falls compared to usual care. Randomized control trials. Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries. A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository. Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute. Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute. Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form. Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients' fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5). Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.

Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study.

BackgroundFalls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool.ObjectiveThe objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care.MethodsA pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents’ falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice.ResultsOver 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents.ConclusionsVideo monitoring offers high potential to support conventional care in memory care facilities.

A Multicomponent Fall Prevention Strategy Reduces Falls at an Academic Medical Center

While the reduction in fall rates has not kept pace with the reduction of other hospital-acquired conditions, patient safety research and quality improvement (QI) initiatives at the system and hospital levels have achieved positive results and provide insights into potentially effective risk reduction strategies. An academic medical center developed a QI-based multicomponent strategy for fall prevention and pilot tested it for six months in three high-risk units-the Neuroscience Acute Care Unit, the Myelosuppression/Stem Cell Transplant Unit, and the Acute Care for the Elderly Unit-before implementing and evaluating the strategy hospitalwide. The multicomponent fall strategy was evaluated using a pre-post study design. The main outcome measures were falls and falls with harm measured in events per 1,000 patient-days. Fall rates were monitored and compared for three classes of falls: (1) accidental, (2) anticipated physiologic, and (3) unanticipated physiologic. Statistical process control charts showed that the pilot units had achieved significant reductions in falls with harm during the last five months of data collection. Wald test and segmented regression analyses revealed significant improvements in pooled postintervention fall rates, stratified by fall type. The hospitalwide implementation of the program resulted in a 47% overall reduction in falls in the postintervention period. A fall prevention strategy that targeted the spectrum of risk factors produced measurable improvement in fall rates and rates of patient harm. Hospitals must continue developing, rigorously testing, and sharing their results and experiences in implementing and sustaining multicomponent fall prevention strategies.

Reducing falls in a care home

Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result.2 A project...

Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups

BackgroundFalls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact.MethodsFour community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers.ResultsThe community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted.ConclusionTo align stakeholders working towards fall prevention for community-dwelling older adults and establish a foundation for collective impact, public health professionals employed practices that reflected a collaborative leadership style. Looking ahead, public health professionals will want to shift their focus to evaluating the effectiveness of their group work within communities. They will also need to assess outcomes and evaluate whether the anticipated reductions in fall rates among community-dwelling older adults is being achieved.

Validation of Fall Risk Assessment Specific to the Inpatient Rehabilitation Facility Setting.

To evaluate and compare the Morse Fall Scale (MFS) and the Casa Colina Fall Risk Assessment Scale (CCFRA) for identification of patients at risk for falling in an acute inpatient rehabilitation facility. The primary objective of this study was to perform a retrospective validation study of the CCFRAS, specifically for use in the inpatient rehabilitation facility (IRF) setting. Retrospective validation study. The study was approved under expedited review by the local Institutional Review Board. Data were collected on all patients admitted to Cottage Rehabiliation Hospital (CRH), a 38-bed acute inpatient rehabilitation hospital, from March 2012 to August 2013. Patients were excluded from the study if they had a length of stay less than 3days or age less than 18. The area under the receiver operating characteristic curve (AUC) and the diagnostic odds ratio were used to examine the differences between the MFS and CCFRAS. AUC between fall scales was compared using the DeLong Test. There were 931 patients included in the study with 62 (6.7%) patient falls. The average age of the population was 68.8 with 503 males (51.2%). The AUC was 0.595 and 0.713 for the MFS and CCFRAS, respectively (0.006). The diagnostic odds ratio of the MFS was 2.0 and 3.6 for the CCFRAS using the recommended cutoffs of 45 for the MFS and 80 for the CCFRAS. The CCFRAS appears to be a better tool in detecting fallers vs. nonfallers specific to the IRF setting. The assessment and identification of patients at high risk for falling is important to implement specific precautions and care for these patients to reduce their risk of falling. The CCFRAS is more clinically relevant in identifying patients at high risk for falling in the IRF setting compared to other fall risk assessments. Implementation of this scale may lead to a reduction in fall rate and injuries from falls as it more appropriately identifies patients at high risk for falling.

Falls prevention in hospitals and mental health units: an extended evaluation of the FallSafe quality improvement project

inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20-30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle. : data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys. : in FallSafe units, delivery of seven care bundle components significantly improved; most improvements were sustained after active project support was withdrawn. Twelve-month moving average of reported fall rates showed a consistent downward trend in FallSafe units but not controls. Significant reductions in reported fall rate were found in FallSafe units (adjusted rate ratio (ARR) 0.75, 95% confidence interval (CI) 0.68-0.84 P < 0.001) in the 12 months following full implementation but not in control units (ARR 0.91, 95% CI 0.81-1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71-1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72-1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%. : introducing evidence-based care bundles of multifactorial assessment and intervention using a quality improvement approach resulted in improved delivery of multifactorial assessment and intervention and significant reductions in fall rates, but not in injurious fall rates.

Communication and effectiveness in a US nursing home quality‐improvement collaborative

In this study, we explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. Survey and interview data were collected from nursing home clinicians participating in a quality-improvement collaborative. Quality-improvement outcomes were evaluated using US Federal and State minimum dataset measures. Models were specified evaluating the relationships between resident outcomes, staff perceptions of communication patterns, and staff perceptions of collaborative effectiveness. Interview data provided deeper understanding of the quantitative findings. Reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings, and where respondents perceived that the collaborative kept them informed and provided new ideas. Clinicians observed that participation in a quality-improvement collaborative positively influenced the ability to share innovative ideas and expand the quality-improvement program within their nursing home. For practitioners, a high level of communication, both inside and outside of meetings, was key to making measurable gains in resident health outcomes.

Abstract TP329: Patient Transfer Check Off Decreases Fall Rate on Stroke Unit

Background and Issues: Protecting stroke patients from falls and injury is fundamental to providing exceptional care. An increased risk for falls has been recognized among persons with diagnoses of stroke and other neurological disorders. Our Stroke Unit’s comprehensive fall prevention program, while helpful, did not adequately identify stroke patients who would fall. While instituting video monitoring of patients at high risk for falls provided a 20% reduction in fall rate, stroke patients evaluated at low and moderate risk continued to fall. Purpose: The purpose of our practice change was to determine if implementing high risk measures on all patients admitted to a stroke unit until demonstration of five safe transfers would decrease the number of patient falls. Methods: Utilizing a shared responsibility model, our Stroke Unit engaged all staff members in the falls prevention program. Each patient was evaluated using the current falls risk assessment tool. If the patient was scored high risk, full falls prevention measures were maintained. For patients scoring low to moderate risk, a safe patient transfer check off procedure was implemented. Each patient was monitored five times to ensure independent demonstration of all aspects of transfer without support. Upon five safe transfers, the patient’s bed alarm could be shut off and general fall preventative measures maintained. Unit secretaries checked the bed alarm system twice a day to monitor proper activation of alarms. A report was created representing the retrieved information for the charge nurse. The charge nurse followed up with nurses whose patient alarms were not on and ensured proper activation. Results: Since implementation of the safe patient transfer check off, we have seen an additional 33% reduction in fall rate compared to our post-implementation of video monitoring rate (3.48/1000 patient days compared to 5.20/1000 patient days). There were zero falls for patients who were successfully checked off on safe transfers. Conclusion: Implementing a safe transfer check off for mild to moderate fall risk patients on a Stroke Unit may be a successful strategy to prevent falls and fall related injuries. Engaging all staff members in the program increased awareness of the importance of falls prevention.