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Overview

Updated on November 30, 2015

Issue

 

A fall is defined as an event or unintentional change in position that results in a person coming to rest inadvertently on the ground or floor or other lower level.1,2 Falls and fall-related injuries are among the most serious and common medical problems experienced by older adults. Even a fall that does not result in an injury can trigger a fear of falling, which can reduce a resident’s mobility, social interactions, and quality of life.3

Health Quality Ontario reported on its public report Long-Term Care web page that in 2014-2015, 14.8% of long-term care residents had a fall in any given 30-day period, changing a little from 14.2% in 2013-2014.3 As well, approximately 25,000 people in residential care across Canada were at risk of falling.4

The good news is that some falls can be prevented. A growing body of research indicates that assessing risk and implementing prevention strategies are effective in reducing falls, thereby maintaining health outcomes and quality of life among seniors. According to the Long-Term Care Homes Act, 2007, all homes in Ontario are required to have a falls prevention and management program, so to enhance your program, you can find evidence informed best practices outlined in the Best Practices tab to support efforts to reduce falls in Ontario.

Call to Action

The overarching goal is to maintain and or improve the quality of life for long-term care residents by preventing and reducing the number and impact of falls, which in turn, will also lessen the burden on the health care system. There has been little to no change in the falls rate over the past several years,3 and the considerable variation in the rate of falls amongst long-term care homes suggests there is room for improvement and better consistency in Ontario’s long-term care homes.3 The provincial target is to bring falls rates down as low as possible.

Ontario is the first jurisdiction that publicly reports on long-term care home specific quality indicators. As you may have already learned, being able to measure and monitor your efforts is one of the first steps in any quality improvement journey. While the tools and information provided in this quality improvement resource focus on the process of quality improvement for the home, the ultimate goal is to provide residents with the best possible care.

  1. Registered Nurses' Association of Ontario. Nursing Best Practices Guidelines: Prevention of Falls and Fall Injuries in the Older Adult.

    Toronto: Registered Nurses' Association of Ontario (RNAO); 2005 Mar.
    Available from: http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf

  2. Canadian Institute for Health Information. Resident Assessment Instrument (RAI) RAI MDS 2.0 User’s Manual.

    Canadian Institute for Health Information; 2012 Feb.
    Available from: https://secure.cihi.ca/estore/productSeries.htm?pc=PCC127

  3. Health Quality Ontario. Measuring Up 2015: A yearly report on how Ontario’s health system is performing.

    Toronto: Queen’s Printer for Ontario; 2015.
    Available from: http://www.hqontario.ca/portals/0/Documents/pr/measuring-up-2015-en.pdf

  4. Health Quality Ontario. Long-term care-Falls

    Public Reporting. 2014
    Available from: http://www.hqontario.ca/Public-Reporting/Long-Term-Care

  5. Preventing Falls: From Evidence to Imrpovement in Canadian Health Care.

    Accreditation Canada, Canadian Institute for Health Information, and Canadian Patient Safety Institute. Ottawa, ON: CIHI; 2014.
    Available from: https://secure.cihi.ca/free_products/FallsJointReportAugust6_2014_CPHI_EN_web.pdf

Best Practices

Updated on November 30, 2015

“By changing nothing, nothing changes.”
Tony Robbins

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.8 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

A 2008 HQO analysis of falls and fall-related injuries in community-dwelling seniors examined the existing literature to identify interventions that may be effective in reducing the probability of a senior falling and/or sustaining a fall-related injury. Eleven interventions were identified in the literature, of which seven had some level of evidence to support their use in preventing falls and fall-related injuries.1 These interventions have been shown to be cost effective.2 For more details on the evidence found for each of these interventions, read the Aging in the Community: Prevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors report.

Listed below are best practices to reduce and prevent falls and related injuries. These are based on literature reviews of evidence for each practice. To help you move from best evidence to best practice, click on the + button next to each best practice to find implementation details, as well as change ideas that you can test using a PDSA approach.

Best practices need to be tailored to client characteristics. The Registered Nurses’ Association of Ontario has created an Implementation Toolkit to guide this process.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747

Measurement

Updated on November 30, 2015

“Some is not a number, soon is not a time.”
Don Berwick, former CEO and President of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator Indicator of Quality Improvement How to Calculate:

numerator
__________

denominator
Targets/ Benchmarks How is This Indicator Used?
Outcome Percentage of residents who had a recent fall (in the last 30 days) Residents who had a fall in the last 30 days recorded on their target assessment
Residents with valid assessments
Targets: As low as possible (set by individual organizations)

Provincial benchmarks:
9%
Quality improvement

QIP indicator

Publicly reported by HQO

Tools & Resources

Updated on November 30, 2015

“Knowledge derived from research and experience may be of little value unless it is put into practice.”
Dr. Judith Shamian, keynote address at the 11th International Nursing Infomatics Conference, Montreal, 2011

Tools

Falls
QI Tools

 

For a more comprehensive list of tools and resources, visit the following links on our HQO website:


 

Resources

Falls
QI Resources