Older adults — people ages 65 and older — are more at risk for falling than any other age group, reports the Centers for Disease Control and Prevention (CDC). In fact, more than 14 million older adults in the United States report falling each year. Many of these falls result in injuries, a need to go to the emergency room (ER) and extended hospital stays. For some older adults, falls can be fatal.
Preventing falls became a leading quality improvement (QI) focus for the team at Wood-Lawn Heights Skilled Nursing Facility and Rehabilitation Center in Batesville, Arkansas. In July 2024 the monthly fall rate at the facility was 36%, which was increasing ER transfers and the workload for staff, said administrator Laurie Herron. However, within three months of developing and implementing a fall prevention program, the monthly fall rate dropped to 21%, a 42% improvement.
“All residents in skilled nursing and long-term care facilities have some level of fall risk,” Herron stated, adding that “different levels of need” makes addressing the issue that much more complex. It is a challenge, but doable with the right plan.
Form a Team
Herron, assistant administrator Debbie Baker and QI specialists from the TMF Quality Innovation Network (QIN) worked together to review interventions that had been successful in helping reduce fall rates at other facilities. This survey of effective practices revealed that meeting residents’ varying needs required assembling an interdisciplinary team; therefore, the Wood-Lawn Heights’ falls team includes staff from several departments, including therapy services, nursing, nursing aides and administration. Baker served as the falls team lead and champion from the start, engaging others along the way.
Once convened, the falls team’s initial goal was to establish and embrace a culture that moved beyond “finger pointing and assigning blame” to one that focused on how falls happen. Such an emphasis helped the team identify processes and practices that needed to be adopted or adjusted to prevent falls.
Assess Practice
After its assembly, the falls team immediately began its work. Using the TMF QIN’s “5 Whys” tool, they honed in on the problem — an increase in residents’ falls — to identify why they were happening.
After finding root causes of the problem, the falls team began writing the Wood-Lawn Heights’ Falls Management Program (FMP), which was approved and launched in just under two weeks. The plan includes protocols for assessing the fall risk for newly admitted residents, readmitted residents, and those who transfer from one room or hall to another. The FMP also helps identify when a resident’s change of condition requires a new assessment.
The falls team uses a comprehensive assessment that includes a risk factor review to address identified fall risk areas, such as medications, orthostatic hypotension, vision, mobility and unsafe behavior. For instance, has the resident started a new medication that hinders their mobility? Does a resident often get dizzy upon standing up? Do they engage in unsafe behaviors, like trying to walk alone despite being asked to wait for assistance?
The assessment also requires team members to inspect living spaces for common safety problems that often lead to falls, and to determine during nursing huddles if all facility staff are informed about each resident’s fall risk.
“Through the Falls Management Program, we have learned to use the strengths of the interdisciplinary team to dive deeper into root causes, and to use standardized practices to ensure we adhere to the appropriate steps for assessing all known risk factors for falls,” Herron said. “Our fall assessment is also used to schedule further assessments with appropriate professionals for each area of risk triggered.”
Enjoy Success, Then Start Again
While the Wood-Lawn Heights FMP has been successful, Herron and Baker know that continued success requires continuous improvement.
“The Falls Management Program is directly tied to our QI processes, which include educating new staff, residents and their family members about our FMP,” Herron said. “It helps that new residents and their families and our resident counsel receive training, too.”
The FMP is an ongoing, data-driven initiative. The TMF QIN specialists explained why it is imperative to use data to show why change is needed, and why it is so important to get regular feedback from all stakeholders affected by resident falls. The falls team reviews monthly reports to pinpoint where fall prevention improvements can be made. That monthly data is compiled annually, so they can see over time how the FMP enhances resident safety, as well as what QI steps should be taken next.
To find out how a TMF Qualified Innovation Network-Quality Improvement Organization (QIN-QIO) specialist can assist your nursing home with quality improvement free of charge, contact NHconnect@tmf.org.