Falls Prevention and Management
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The purpose of this guideline is to outline evidence-based approaches for preventing falls and reducing fall injuries for adults.
Registered Nurses’ Association of Ontario. (2017). RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. This work is funded by the Ontario Ministry of Health and Long-Term Care
http://rnao.ca/bpg/guidelines/prevention-falls-and-fall-injuries
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A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.
Registered Nurses Association of Ontario (2022) Gap Analysis- Preventing Falls and Reducing Injury from Falls. Toronto. ON
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A summary of the recommendations of RNAOs Best Practice Guideline on Preventing Falls and Reducing Injury from Falls (4th ed.).
Registered Nurses’ Association of Ontario. (2017). RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.11-14). -
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This document contains sample program objectives, policy, procedures, staff training materials and tools related to fall prevention. (Member login is not required. The documents may be accessed by scrolling to the bottom of page.)
Ontario Association of Non-profit homes and services for seniors. (2011). OANHSS LTCHA Implementation Member Support Project. Fall Prevention and Management Program: Policy, Procedures and Training Package. Copyright 2011.
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A Successful story of a Falls Prevention Program.
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Appendix F - provides a summary of related approaches and tools for assessing fall risk. The tools are categorized as follows: gait and balance; general fall risk and fear of falls. It is important for the organization to review the findings to support selection of tools for settings and population(s) served noting that other tools are available that address specific risk factors.
Registered Nurses’ Association of Ontario. (2017). Appendix F of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.92-97) -
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Best Practices for Developing an Effective Fall Huddle Program
© 2023 SafelyYou, Inc.
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This table lists common components of universal falls precautions that health care organizations can determine which precautions are applicable to their setting.
Registered Nurses’ Association of Ontario. (2017). Appendix K of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.113) -
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Table 18 summarizes different approaches to exercise and physical training interventions with varying degrees of effectiveness.
Registered Nurses’ Association of Ontario. (2017). Appendix H of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.104-107.) -
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Fallsloop is a free online communication platform for the virtual Falls community of practice (CoP). Practitioners, caregivers, researchers, older adult groups and policy planners working for the health and care of older adults come together to exchange information to problem solve and learn to implement evidence-informed and promising fall prevention practices. Register to join the Falls CoP and access free webinars and resources.
The Ontario Neurotrauma Foundation (n.d.) Fall Prevention Community of Practice Loop. Retrieved from www.fallsloop.com -
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A fall prevention toolkit for planning events, information on evidence informed and evaluated fall prevention programs, resources and tools for practitioners and promotional materials for organizations.
Fall Prevention Month. (n.d.). Fall prevention month toolkit. http://fallpreventionmonth.ca/ -
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Example of a form for documentation from St Joseph’s Healthcare Hamilton on falls debriefing and action plan.
Registered Nurses’ Association of Ontario. (2017). Appendix J: Example: Falls debriefing and action plan from St. Joseph's Healthcare Hamilton (Ontario, Canada) of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.111-112.) -
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The Falls Risk Management (FRM) Post‐Falls Review sets out to describe the elements that are required for a post‐falls review within a comprehensive FRM strategy to support patient safety and quality improvement. https://www.fallpreventionmonth.ca/uploads/2019%20toolkit/Post%20Falls%20Review.pdf
Alberta Health © 2023 Government of Alberta
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A flow chart that summarizes the steps, context, and considerations in falls prevention and injury reduction.
Registered Nurses’ Association of Ontario. (2017). RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.24) -
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These open-access interactive geriatric learning modules are based on the Geriatrics interprofessional interorganizational Collaboration (GiiC) toolkit developed by the RGPs of Ontario. Users take on a senior character and follow their journey through the health system. Registration is required to access the eLearning Modules.
Retrieved from: https://geriatricessentialselearning.ca/
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Example signage of Intentional Hourly Rounding Poster from Fraser Health, British Columbia, Canada.
Registered Nurses’ Association of Ontario. (2017). Appendix K of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.115) -
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Table-14, 15, 16 and 17 summarize evidence from the reviewed literature on specific fall prevention and injury reduction interventions. They are organized according to the benefit of the interventions. Health-care providers use clinical judgment to determine if interventions apply to their settings.
- Table 14: interventions with strong evidence of benefit.
- Table 15: interventions that have potential benefit.
- Table 16: interventions with mixed findings.
- Table 17: interventions with insufficient evidence of benefit.
Registered Nurses’ Association of Ontario. (2017). Appendix G of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.98-103) -
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Tables 10, 11 and 12 list of risk factors that include fall risk factors, health conditions associated with increased risk of falls, and factors associated with increased risk of falls injury.
Registered Nurses’ Association of Ontario. (2017). Appendix E of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.88-91.) -
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LTC Series - Personal Support Worker: How to Safely Transfer In and Out of Bed is a two minute Osteoporosis Canada video discusses and demonstrates how to safely transfer residents in and out of bed.
Osteoporosis Canada. [GERAS Centre]. (2018, Feb 8). LTC Series - Personal Support Worker: How to Safely Transfer Out/In Bed [Video]. YouTube. https://www.youtube.com/watch?v=3l93LkyHyLY&t=5s -
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LTC Series - Personal Support Worker: Practicing Sit to Stands Daily is a two and a half minute Osteoporosis Canada video discusses and demonstrates how to do daily sit to stand exercises for long term care residents.
Osteoporosis Canada. [GERAS Centre]. (2018, Feb 8). LTC Series - Personal Support Worker: Practicing Sit to Stands Daily [Video]. YouTube. https://www.youtube.com/watch?v=yUWg3x6LUgU -
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LTC Series - Personal Support Worker: Proper Positioning for Sitting is a one and a half minute Osteoporosis Canada video discusses and demonstrates how to properly position residents for sitting.
Osteoporosis Canada. [GERAS Centre]. (2018, Feb 8). LTC Series - Personal Support Worker: Proper positioning for sitting. [Video]. YouTube. https://www.youtube.com/watch?v=ssxzMpcCRDM -
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Table 19 provides a list of medication resources for use in fall prevention and reduction of injury from falls.
Registered Nurses’ Association of Ontario. (2017). Appendix I of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.108.) -
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Ontario Regulation 246/22 was made under The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector April 11, 2022.
Government of Ontario (2022) Ontario Regulation 246/22. Toronto ( ON) retrieved from O. Reg. 246/22: GENERAL (ontario.ca)
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This website is a source of information created for Ontario Long-term care homes regarding osteoporosis and fracture prevention. It includes resources, tools and the recommendations for preventing fractures in long-term care.
Geriatric Education and Research in Aging Sciences (GERAS). (n.d.). Osteoporosis Long-Term Care. Retrieved from https://www.gerascentre.ca/osteoporosis-strategy-for-long-term-care/
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Table 20 is a description of resources available to support post fall assessments.
Registered Nurses’ Association of Ontario. (2017). Appendix J of RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. (p.109-110) -
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This article highlights the impact of implementing the RNAO Falls Best practice guideline.
Laviolette, K. (2020). Purposeful hourly rounding in long-term-care. Canadian Nurses Association. https://www.canadian-nurse.com/en/articles/issues/2020/april-2020/purposeful-hourly-rounding-in-long-term-care Copyright ©, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario, K2P 1E2 CANADA, 2018 all rights reserved
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A validated fall risk self-assessment tool developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center and affiliates.
Seniors BC, Authors: Vivrette, Rubenstein, Martin, Josephson & Kramer, 2011). This brochure is adapted with the permission of J.Stevens, R.Vivrette, J.Kramer, & L. Rubenstein
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Centres for Disease Control and Prevention developed the STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative which includes educational materials and tools to improve fall prevention.
https://www.cdc.gov/steadi/patient.html
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This falls prevention poster lists approaches for safe environments, mobility, fall risk reduction and engaging patients and families.
Sources: Degelau et al., 2012; Scott, 2013; Wallis & Campbell, 2011.
Registered Nurses’ Association of Ontario. (2017). RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.). Toronto, ON: Author. Pg. 115
This work is funded by the Ontario Ministry of Health and Long-Term Care
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Webinar Presentation by Vision Nursing Home's Kathleen Waller, BPSO Lead and Charge Nurse An overview of Vision Nursing Home's journey through their BPSO year one candidacy while implementing the Best Practice Guideline on Prevention of Falls and Fall Injuries in the Older Adult. It highlights strategies and processes during implementation and for sustainability, includes challenges and successes, data collection, monitoring and evaluation.
Kathleen Waller. [Registered Nurses' Association of Ontario]. (2016, Jan 28). Best Practice Spotlight Organization's journey in implementing the Prevention of Falls in the Elderly best practice guideline. [Video]. YouTube. https://youtu.be/gSqA_7fduWA