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Elderly/Long-term Care

Adverse incident reporting system improves documentation of falls in nursing homes to guide prevention of future falls

One-half of all nursing home residents fall each year. The first step in reducing these sometimes serious falls is to find out how they happened, so that interventions can be put in place to prevent future falls. One such approach is a falls menu-driven incident-reporting system (MDIRS). In a study supported by the Agency for Healthcare Research and Quality (HS11588), the system was tested over a 4-month period for its effect on quality improvement efforts at three nursing homes. Laura M. Wagner, Ph.D., R.N., of the Baycrest Centre for Geriatric Care, and colleagues compared documentation of fall incidents at the three homes with three matched homes that used existing narrative incident reports to document falls.

Nearly one-third of the 910 residents at the 6 facilities fell during the 4-month study period. MDIRS nursing homes had significantly better documentation of fall characteristics on the incident reports than did the control nursing homes. The MDIRS allows a person reporting a fall to just "point and click" on a menu of options related to the fall rather than trying to evaluate it in the unstructured manner typical of traditional narrative incident reports. For example, the MDIRS form prompts health care workers to state how they found the person who fell or whether they witnessed the fall, the cause (for example, lost balance, slipped, lost strength, tripped, lost consciousness/seizure, other causes), the fall location, and footwear at the time of the fall.

A significantly greater proportion of fall type (for example, witnessed, unwitnessed, or near fall), circumstances, bed side-rail status, and restraint status were documented in MDIRS than control homes. Two of the three MDIRS homes used the MDIRS software to develop charts and graphs in quality improvement meetings. As a result of these data, one nursing home reported a problem with restraint-related falls and planned to implement a restraint-reduction program. The quality improvement minutes of control homes were limited to the number of fall incidents and associated injuries.

More details are in "Impact of falls, menu-driven incident-reporting system on documentation and quality improvement in nursing homes," by Dr. Wagner, Elizabeth Capezuti, Ph.D., R.N., F.A.A.N., Jo A. Taylor, R.N., M.P.H., and others, in the December 2005 Gerontologist 45(6), pp. 835-842.

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