FAQ | Contact Us | Advertise  | RSS Feed
Subscribe to this feed
ADVANCE for Long-Term Care Management RSS Feed
Search
Login | Sign Up

Current Issue

Subscriptions are FREE to Qualified Long-Term Care Professionals


Tables and Figures

Product Report: Fall Prevention


Print ArticleEmail Article

TABLE 1:  METHODS FOR CALCULATING FALL INCIDENCE RATES

METHOD

ADVANTAGES

DISADVANTAGES

Number of falls per bed or per 1,000 beds

Easy to calculate

Useful in facilities and units with stable/consistent occupancy rates

Fluctuations in occupancy rates can artificially elevate or lower rate

One patient with multiple falls can significantly raise rate

Number of falls per patients or per 1,000 patients

Easy to calculate

Useful in facilities or units with patients having stable lengths of stay, e.g., 7-8 days

Under estimates fall incidence when one patient falls more than once

One patient with multiple falls can significantly raise incidence rate

Variations in length of stay can result in under/over estimates, e.g., shorter lengths of stay patients have fewer opportunities to fall and longer lengths of stay patients have more opportunities to fall

Number of falls per 1,000 or 10,000 patient-days

Best for computing rates in facilities with varying case-mix, lengths of stays, and occupancy

Accounts for daily fall risk making estimates more accurate, e.g., shorter lengths of stay patients have fewer opportunities to fall and longer lengths of stay patients have more opportunities to fall

JCAHO recommended method

More difficult to calculate

May be less meaningful for smaller facilities

May be less meaningful for shorter observation periods

Number of falls per 100 patient-years

Often used in research studies to combine fall incidence rates that are collected over unequal periods of time, e.g., 6 months, 1 year, 18 months More difficult to calculate

Less meaningful for smaller facilities

Less meaningful for shorter observation periods

TABLE 2: FACTORS COMMONLY ASSOCIATED WITH FALLS
FALL CHARACTERISTICS FALLER  CHARACTERISTICS UNIT CHARACTERISTICS
Date/day of the week

Time of day/shift

Place the fall occurred

Activity that led to the fall, e.g., patient transfer, during mealtimes

Witnessed/unwitnessed

Injury:

- None- does not cause any type of physical, emotional or psychological harm and requires no medical or nursing care;

- Level I-requires little or no medical care, e.g., abrasions, cuts, or bruises;

- Level II-requires some medical and/or nursing intervention or observation, e.g., sprains, deep lacerations, splinting;

- Level III- requires medical intervention or consultation, e.g., fracture, change in level of consciousness or functional status.

History of falls

Multiple unit transfers

Age >70

Neurological/motor dysfunction, e.g., cerebral vascular accident, Parkinson's disease

Impaired vision

Impaired cognition

Syncopy, dizziness, or vertigo

Nocturia

Medications-specifically-psychotropics, sedatives, cardiovascular agents, diuretics

Recent medication change

Recent change in status

Unit census

Patient/staff ratio

Patient Acuity Index

Staff mix

Unit manager present

New admissions to unit

Emergency occurrence on unit, e.g., patient with cardiac arrested, readmission to acute hospital

Agency/temporary personnel working on unit

TABLE 3: FALL PREVENTION STRATEGIES
PATIENT-FOCUSED

ENVIRONMENT-FOCUSED

STAFF-FOCUSED

Routine risk assessment & identification of high risk patients

Wristbands to alert staff of fall risk

Stickers placed on medical charts, patient rooms, wheelchairs

Foot care

Properly fitting low slip shoes

Properly fitting clothes

Encourage use of eye glasses

Motion detectors

Establish toileting program

Schedule/plan activity and rest periods

Identify sleep/wake patterns

Hip protectors

Encourage use of assistive devices

Sitters

Reduce hall and room clutter

Mount televisions on wall

Increase patient storage space

Proper lighting-minimal glare

Hallway and room handrails

Low toilet seats

Nonslip flooring

Large print clocks and calendars

Attend to spills quickly

Awareness
High-risk patients
Identify vulnerable unit activities & alert all staff

Staff & Family education
Fall characteristics
Patient characteristics
Unit characteristics
Prevention strategies

Develop good practice habits:
Call bell within reach
Before leaving patient alone ask about toileting needs
Before leaving patient along review environment for potential trip/slip hazards
Lock wheelchairs and beds
Return bed to lowest position

 

FIGURE 1: CALCULATING A RATE AVERAGE AND STANDARD DEVIATION
  Monthly Fall Rate   Rate - Average =         (Rate - Average)2 =    
  July 17   17-10= 7. 49 49  
  August 13   13-10= 3. 9 9  
  September 5   5-10= -5. 25 25  
  October 13   13-10= 3. 9 9  
  November 9   9-10= -1. 1 1  
  December 12   2. 4 4
January 11

11-10=

1. 1 1  
  February 14  

14-10=

4. 16 16  
 

March

7  

6-10=

-4. 16 16  
  May 6  

6-10=

-2. 4 4  

Average =

Sum

121   Standard Deviation =   Sum of (Rate - Average) 2 159 13.3
  # of Months 12       # of Months 12  
                 
 

Average =

10   Standard Deviation =   3.6    

FIGURE 2: CREATE A PICTURE

Step1: Chart monthly rates




 

Search Jobs

Zip

Go