A model quality improvement program for the management of falls in nursing homes

There is an urgent need for model programs to effectively manage fall risk in nursing homes. Such programs should use best practices and quality improvement (QI) methodology in a manner that is practical for sustained implementation in the current resource-constrained long-term care environment. The Falls Management Program (FMP) represents 13 years of fieldwork (1993-2006). It is an interdisciplinary, multifaceted approach to reducing fall risk that includes systematic screening, assessment, individualized care planning, resident monitoring, and the elimination of environmental safety hazards. The FMP is initiated by a self-assessment process that assists nursing homes in identifying areas that need improvement so that staff can tailor implementation to their own facility's needs. The FMP incorporates education on best practices and uses several QI tools designed to assist nursing homes with program implementation. Core components of the program include administrative and clinical leadership, interdisciplinary teamwork using QI methodology, support by advance practice nurses, and an 8-step fall response system to facilitate the comprehensive investigation and documentation of falls, primary care provider involvement, and development of individualized fall risk reduction strategies.