Gap Analysis - Prevention of Falls and Fall Injuries in the Older Adult
Gap Analysis:
Prevention ofFalls and Fall Injuries in theOlder Adult, Revised 2011
Work Sheet
This guideline can be downloaded for free at:
The RNAO Toolkit: Implementation of Best Practice Guidelines, Second Edition is also available at:
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Gap Analysis - Prevention of Falls and Fall Injuries in the Older Adult
Team Members participating in the Gap Analysis:
Completion of this gap analysis allows for the annual comparison of your current practice to evidence-based practices as regulated by the MOHLTC. See Appendix A for this and other regulations that apply to a falls program in your home.
RNAO Best Practice Guideline Recommendations / Met / PartiallyMet / Unmet / Notes(Examples of what to include: is this a priority to our home, information on current practice, possible overlap with other programs or partners)
Practice Recommendation: Assessment
1.0 Assess fall risk on admission.
(Level of Evidence = Ib)
1.1 Assess fall risk after a fall.
(Level of Evidence = Ib)
Practice Recommendation: Interventions
Multi-factorial
2.0 Nurses as part of the interprofessional team, implement multi-factorial fall prevention interventions to prevent future falls.
(Level of Evidence = Ib)
Exercise
2.1 Nurses support physical training as a component of multi-factorial fall intervention program taking into consideration client risk factors.
(Level of Evidence = Ib)
Medications
2.2 Nurses in consultation with the health care team, should conduct medication reviews on admission and periodically throughout the continuum of clients’ care to prevent falls among older adults in healthcare settings. Clients taking multiple and known high risk medications should be identified at higher risk for falls.
(Level of Evidence = Ia)
Hip Protectors
2.3 Nurses could consider the use of hip protectors to reduce hip fractures among those clients considered at high risk of fractures associated with falls; however, there is no evidence to support universal use of hip protectors among the older adult in healthcare settings.
(Level of Evidence = Ib)
Vitamin D
2.4 Nurses provide clients with information on the benefits of vitamin D supplementation in relation to reducing fall risk. In addition, information on dietary, life style, and treatment choice for the prevention of osteoporosis is relevant in relation to reducing the risk of fracture.
(Level of Evidence =Ia)
Client Education
2.5 All clients who have been assessed as high risk for falling receive education regarding their risk of falling.
(Level of Evidence = IV)
Environment
2.6 Nurses include environmental modifications as a component of fall prevention strategies.
(Level of evidence =Ib)
Education Recommendation: Nursing Education
3.0 Education on the prevention of falls and fall injuries should be included in nursing curricula and on-going education with specific attention to:
- Promoting safe mobility;
- Risk assessment;
- Interprofessional strategies;
- Risk management including post-fall follow-up;
- Alternatives to restraints and/or other restricted devices;
- Frequent bedside nursing visits; and
- Safe mobility and toileting.
Organization and Policy Recommendation: Least Restraint
4.0 Nurses should not use side rails for the prevention of falls or recurrent falls for clients receiving care in health care facilities; however, other client factors may influence decision-making around the use of side rails.
(Level of Evidence = IIb)
4.1 Organizations establish a corporate policy for least restraint that includes components of physical and chemical restraints.
(Level of Evidence = IV)
Organization and Policy Recommendation: Organizational Support
5.0 Organizations create an environment that supports interventions for fall prevention that includes:
- Fall prevention programs;
- Staff education;
- Clinical consultation for risk assessment and intervention;
- Involvement of interprofessional teams in case management; and
- Availability of supplies and equipment such as transfer devices, high low beds, and bed exit alarms.
Organization and Policy Recommendations: Medication Review
5.1 Organizations implement processes to effectively manage polypharmacy and psychotropic medications including regular medication reviews and exploration of alternatives to psychotropic medication for sedation.
(Level of Evidence = IV)
Organization and Policy Recommendations: RNAO Toolkit
6.0 Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. Organizations may wish to develop a plan for implementation that includes:
- An assessment of organizational readiness and barriers to education
- Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process.
- Dedication of a qualified individual to provide the support needed for the education and implementation process.
- Ongoing opportunities for discussion and education to reinforce the importance of best practices.
- Opportunities for reflection on personal and organizational experience in implementing guidelines.
(Level of Evidence = IV)
Appendix A
Applicable Ministry of Health and Long-Term Care Regulations for a Falls Prevention and Management Program
Required programs48. (1) Every licensee of a long-term care home shall ensure that the following interdisciplinary programs are developed and implemented in the home:
1. A falls prevention and management program to reduce the incidence of falls and the risk of injury.
(2) Each program must, in addition to meeting the requirements set out in section 30,
(a) provide for screening protocols; and
(b) provide for assessment and reassessment instruments. O. Reg. 79/10, s. 48 (2).
Section 30
30. (1) Every licensee of a long-term care home shall ensure that the following is complied with in respect of each of the organized programs required under sections 8 to 16 of the Act and each of the interdisciplinary programs required under section 48 of this Regulation:
1. There must be a written description of the program that includes its goals and objectives and relevant policies, procedures and protocols and provides for methods to reduce risk and monitor outcomes, including protocols for the referral of residents to specialized resources where required.
2. Where, under the program, staff use any equipment, supplies, devices, assistive aids or positioning aids with respect to a resident, the equipment, supplies, devices or aids are appropriate for the resident based on the resident’s condition.
3. The program must be evaluated and updated at least annually in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices.
4. The licensee shall keep a written record relating to each evaluation under paragraph 3 that includes the date of the evaluation, the names of the persons who participated in the evaluation, a summary of the changes made and the date that those changes were implemented. O. Reg. 79/10, s. 30 (1).
(2) The licensee shall ensure that any actions taken with respect to a resident under a program, including assessments, reassessments, interventions and the resident’s responses to interventions are documented. O. Reg. 79/10, s. 30 (2).
Falls prevention and management
49. (1) The falls prevention and management program must, at a minimum, provide for strategies to reduce or mitigate falls, including the monitoring of residents, the review of residents’ drug regimes, the implementation of restorative care approaches and the use of equipment, supplies, devices and assistive aids. O. Reg. 79/10, s. 49 (1).
(2) Every licensee of a long-term care home shall ensure that when a resident has fallen, the resident is assessed and that where the condition or circumstances of the resident require, a post-fall assessment is conducted using a clinically appropriate assessment instrument that is specifically designed for falls. O. Reg. 79/10, s. 49 (2).
(3) Every licensee of a long-term care home shall ensure that the equipment, supplies, devices and assistive aids referred to in subsection (1) are readily available at the home. O. Reg. 79/10, s. 49 (3).
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