Resources: Falls prevention and management 

The following resource is designed to assist Long-Term Care (LTC) homes with the implementation of the Prevention of Falls and Fall Injuries in the Older Adult Best Practice Guideline. Documents found in this resource are evidence-based, but it is not a program plan. Each LTC home is unique and each home is in various stages of guideline implementation. LTC homes are advised to use the resource at their discretion. For those resources that have copyright notations, it is recommended that LTC homes obtain permission from the primary author prior to implementing them within their setting. The Toolkit is a dynamic resource, and is being updated and revised on a regular basis by the LTC Best Practices Initiative team. Visit this site often to see what's new!

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Best Practices/Standards
ResourceLink
RNAO Best Practice Guideline (BPG) Prevention of Falls and Fall Injuries in the Older Adult
RNAO Prévention des chutes et des blessures associées chez la personne âgée

RNAO Best Practice Guideline (BPG) Prevention of Falls and Fall Injuries in the Older Adult in French.

RNAO BPG - Summary of Recommendations for Prevention of Falls and Fall Injuries in the Older Adult
RNAO Prevention of Falls and Fall Injuries in the Older Adult PDA Guideline

Condensed version of the Falls BPG viewable on Personal Digital Assistants (PDAs) or mobile phones.

College of Nurses of Ontario Practice Standards Restraint Policy
Includes restraint descriptions, least restraint policy, and nursing responsibilities.
Gap Analysis Worksheet on Prevention of Falls and Fall Injuries in the Older Adult
Updated February 2014.
Patient Restraints Minimization Act 2001

The government of Ontario's Act on restraints.

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Risk Assessment Tools
ResourceLink

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Assessment Tools
ResourceLink
Berg Balance Scale

This scale rates a resident’s balance, and in turn, can be used to help determine resident fall risk.  Available at http://www.fallpreventiontaskforce.org/pdf/BergBalanceScale.pdf.

MOHLTC Critical Incident

This form is mandatory for falls resulting in significant injury.  It would be best to incorporate this form into policy and procedure.

Morse Falls Scale

This scale requires systematic, reliable assessment of a client’s fall risk factors upon admission, after a fall, with a change in status, and at discharge or transfer to a new setting. Available: The National Center for Patient Safety (NCPS). Author: Morse, J. M., Morse, R., & Tylko, S. (1989)

Post Fall Investigation

The incident reporting forms help determine who fell and why, and looking at these factors help discover how to prevent falls.

Tinetti Balance and Gait Evaluation Tool

These tools can be found and a tutorial is available at http://geriatrics.uthscsa.edu/tools/TINETTI.pdf.

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Planning & Implementation Tools
ResourceLink
RNAO Toolkit: Implementation of Best Practice Guidelines, Second Edition

This Toolkit was designed to assist health care settings in maximizing the potential of Clinical Practice Guidelines through systematic and well-planned implementation. It was also designed to accompany the Nursing Best Practice Guidelines (NBPGs) developed by the Registered Nurses' Association of Ontario (RNAO) in order to facilitate their implementation.

RNAO's Best Practice Guideline Implementation: Project Plan

This project plan is intended to be used as an example in organizations wishing to develop an implementation strategy of their own. The project plan demonstrates how and when implementation of the RNAO BPG will occur, by showing the major milestones of the project, and the activities and resources required to meet these goals.

RNAO's Sustainability of Best Practice Guideline Implementation

Examine sustainability of guideline implementation through strategies associated with sustainability.
Using the Ottawa Model,learn a framework for sustainability and investigate considerations for evaluating success.

RNAO Best Practice Champion Network

RNAO provides free training and networking opportunities to nurture skills in implementing best practice guidelines for individuals and teams.

RNAO's ABCs for BPGs

A workbook designed to introduce nurses and other interprofessional team members in Long-Term Care to the basics of best practice guideline implementation.

RNAO Trousse: Mise en oeuvre des lignes directrices sur les pratiques exemplaires, Deuxième édition

Mise en place des lignes directrices pour la pratique clinique.

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Quality Improvement Tools
ResourceLink
Health Quality Ontario (HQO) | Qualité des services de santé Ontario

This link provides information and resources about quality improvement and related initiatives in Ontario.
En haut de la page principale, il y a un hyperlien pour la version française de ce document.

Health Quality Ontario: Quality Improvement Guide for Long-Term Care (English)

This document provides information and tips on using various quality improvement tools.

RNAO Toolbox for Implementation of a Falls Prevention Program in Long-Term Care

A guide complete with a case study illustrating each step in the process to implement a falls prevention program for residents in long-term care.  

Helpful Hints for BPG Implementation in LTC Series: Edition #2 Hillsdale Estates and Hillsdale Terraces

Sharing implementation tips for a falls prevention program from Best Practice Champions.
 

Helpful Hints for BPG Implementation in LTC Series: Edition #4 Unionville Home Society

Sharing implementation tips for a falls prevention program from Best Practice Champions.

Health Quality Ontario: Residents First Tools and Resources, Change Packages and External Resources

This website provides links to downloadable information to help with project accessibility and efficiency through the use of quality improvement tools.

Institute for Healthcare Improvement (IHI): Model for Improvement

Developed by Associates in Process Improvement. A simple tool that offers a wide range of resources and teaching tools to help health-care professionals lead effective improvement efforts, enhance clinical outcomes, and reduce risks

PDSA Worksheet

The Plan-Do-Study-Act (PDSA) or Deming Cycle worksheet is a quality improvement tool that is an excellent method to first identify the possible ideas for improvement and then test each of them out thoroughly. This is done in a rapid succession of small tests, each test trying out different variations or combinations of ideas.

PDSA Cycle Log Worksheet

The Plan-Do-Study-Act (PDSA) or Deming Cycle worksheet is used to track rapid PDSA cycles developed to improve processes in general practice for program implementation.

AIMS Worksheet Implementation Tool

The AIMS worksheet and diagram can be used to set the goals “what” and the strategies “how” when implementing the recommendations listed in the best practice guidelines.

AIMS Diagram

The AIMS worksheet and diagram can be used to set the goals “what” and the strategies “how” when implementing the recommendations listed in best practice guidelines.

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Additional Implementation Resources
ResourceLink
Implementation Strategies for Prevention of Falls and Fall Injuries in the older adult

These implementation strategies are found in the best practice guideline on the prevention of falls and fall injuries in the older adult.

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Policies and Procedures
ResourceLink
OANHSS Fall Prevention and Management Program - Policy, Procedures and Training Package

This document contains sample program objectives, policy, procedures and staff training materials and tools that meet the minimum requirements of the LTCHA and regulation. Obtained with permission. Source: Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS). Release Date: November 19, 2010.  Revised: March 31, 2011.  Web: http://www.oanhss.org

OANHSS Minimizing Restraining of Residents and the Use of Personal Assistance Service Devices (PASDs) - Policy, Procedures and Training Package

This document contains sample program objectives, policy, procedures and staff training materials and tools that meet the minimum requirements of the LTCHA and regulation. Obtained with permission. Source: Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS). Release Date: December 3, 2010. Web: http://www.oanhss.org.

Policy and Procedure Falls Prevention and Management

Samples of Policies and Procedures that can be adapted to your home. Released: September 2006.

Mississauga Halton Falls Prevention Project: Long Term Care Falls Assessment Algorithm (pg. 45)
Attributed to a falls prevention program from Queensland Australia. The algorithm on page 45 is a decision tree for fall risk assessment on admission and after falls occur.

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Care Planning
ResourceLink
RAI-MDS and RAPs

The Resident Assessment Instrument/Minimum Data Set (RAI-MDS) triggers a Falls RAP (Resident Assessment Protocol) for residents at risk for falling.

Falls Risk Checklist
Checklist to assist in care planning developed by the Toronto Best Practice Initiative.

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Education Resources
ResourceLink
Self Learning and PowerPoint Presentations
RNAO's Falls Prevention: Building the Foundation for Safety

A self learning package for health care workers on identifying and modifying falls risk.

Falls Prevention and Management PowerPoint presentation

Slides to educate staff on falls risk and prevention.  Prepared by Hazelynn Kinney, previous LTC Best Practice Coordinator, Central East Region.  Based on the Toronto Best Practice Implementation Steering Committee’s Policy and Procedure ‘Falls Prevention and Management’ (2006).

Falls and Stroke

Slides addressing stroke and falls risk developed by the Central South Stroke Strategy.

Charts
Fact Sheets / Pamphlets / Pocket Cards / Logos
RNAO Fact Sheet – Reduce Your Risks for Falls
Highlights strategies for reducing fall risks. It is aimed at residents and families with recommendations for action based on the falls prevention guideline.
RNAO Réduire les risques de chute

RNAO Fiche de renseignements pour la sensibilisation en matière de santé.

RNAO Falls Pocket Card
This is a pocket card developed by RNAO based on the RNAO Falls Prevention BPG.
RNAO: BPGs to the Bedside – Action for Personal Support Workers

A series of fact sheets to increase Personal Support Worker’s (PSW) knowledge of how they can prevent resident falls.

The Bones Issue BP Blogger Newsletter January 2008
Videos
Educational DVD on Osteoporosis and Fracture Prevention in Long-Term Care

This is a 10-minute DVD linking osteoporosis and falls prevention.  The Osteoporosis strategy will be distributing a free copy of this DVD to each of Ontario’s LTC homes in the winter of 2009.  If you wish to order an additional copy contact the Osteoporosis strategy at: http://www.osteostrategy.on.ca/multimedia/Purchase%20Order%20Form%20Osteoporosis%20LTC%20online.

Websites
Falls in Long Term Care
Includes links to information on falls assessment, management, and restraints.
New South Wales Falls Prevention Network (Australia)
This website provides an Australian perspective on falls prevention.
Prevention of Falls Network Europe (ProFaNE)
This website provides a European perspective on falls prevention.
Education Resources
Canadian Falls Prevention Curriculum© (CFPC) - Summary

The Canadian Falls Prevention Curriculum© (CFPC) is designed to build on existing knowledge and skills of health professionals and community leaders working in the area of falls prevention among older adults (those 65 and over). The CFPC was developed under the leadership of Dr. Vicky Scott, Senior Advisor on Fall and Injury Prevention for the British Columbia Health Authorities and a team of experts in fall prevention from across Canada.

Universities/Colleges: Canadian Falls Prevention Curriculum© (CFPC) - E-Learning Course

University of Victoria, BC. HPPD215 2009F D01
Those working with older adults in long term care, acute care, and home care will acquire the knowledge and skills needed to apply an evidence-based approach to the prevention of falls and fall-related injuries. Learn how to design, implement, and evaluate a falls prevention program. Facilitated instruction leads you through a process to develop strategies and interventions; apply current programs; understand the reliability and validity of existing resources and tools for screening and assessing fall risk. This distance course begins with a workshop on how to access online components of this course, locate website resources, and communicate with the instructor and other students using online discussion tools to participate in interactive activities throughout this course.

Hamilton Self Assessment Test

Found in: Hamilton Health Sciences (2008). Best Practice for Prevention of Falls.

Other Resources
Assistive Devices Program (ADP)
For resident purchase of devices such as walkers; talk to the physiotherapist in your home.
Falls Risk Factor Identification from the World Health Organization

A study about fall risk factors and interventions for falls. Todd C, Skelton D (2004). What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report; http://www.euro.who.int/document/E82552.pdf, accessed February 2009).

Restraints (a column from the Nursing Issues section of the RNAO website)
An Advanced Practice Nurse in Ottawa responds to a student nurse’s question about understanding the appropriate use of restraints. Written from an Ontario perspective it contains reference to documents to help support practitioners use of the CNO guidelines and the Restraint Minimization Act.
Set me Free: Towards Reducing The Use of Physical Restraints

A resource for service providers on reducing restraint use in the health care setting.  Order form resource only.

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Evaluation
ResourceLink
RNAO Evaluating Your Success

From RNAO’s Toolkit: Implementation of Clinical Practice Guidelines, Chapter 5, pages 57-64.

The Evaluation Center – Western Michigan University

This contains checklists and tools for planning your evaluation.

Public Health Agency of Canada - A Guide to Project Evaluation: A participatory approach | Guide d'évaluation de projet: Une démarche participative

This evaluation guide provides an easy-to-use comprehensive framework for project evaluation. 
En haut de la page principale, il y a un hyperlien pour la version française de ce document. 

Action Plan Template

This resource is a word document worksheet from the clinical implementation toolkit. It can be used both developing your action plan and an evaluation column for your program. Source: RNAO Toolkit: Implementation of Clinical Practice Guideline, 2002, pg 77-79.

Restraint Prevalence Tools from Nursing Best Practice Research Unit (page 12)
This tool measures the prevalence of restraint use in the home; developed and piloted by the Nursing Best Practice Research Unit at the University of Ottawa. Website: www.nbpru.ca.
RNAO Évaluation de votre succès

Faits saillants chapitre entier et une partie de boîte à outils liant qui est déjà mentionné dans la section de planification. Source de L’Association des infirmières et infirmiers autorisés de l’Ontario: Trousse sur la marche à suivre. Mars 2002, page 59-66.

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Recommended Readings/References
ResourceLink
Falls Assessment Tools
This site provides a critique of tools and associated costs. The actual tool is not included in this website. To locate the desired tool, an internet search is recommended.
Hip Protectors – study
This is a National Health Service study from England which looks at the use and selection of Hip protectors.
Mississauga Halton LHIN report on Falls Prevention
This is a comprehensive falls prevention resource guide outlining everything you need to start a falls prevention program at your home.
Stepping In: Long-Term Care Collaborative Falls Prevention Project
This is a falls project summary report from Victoria, BC. It describes the need for a falls reporting form and prevention protocols. Appendix A outlines environmental initiatives, target residents & personnel and costs from the environmental changes related to the project.
Systematic Review of Mobility Assessment Tools

A published report compiled by the British Columbia Injury Research and Prevention Unit looking at assessment tools across different settings including LTC. http://www.injuryresearch.bc.ca/categorypages.aspx?catid=1&subcatid=7&catname=Injury%20Topics&subcatname=Falls%20Prevention Reference: Scott, V., Votova, K., Scanlan, A., Close, J. (2007).
Read more...

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