Implementing and sustaining evidence-based practices in long-term care.

Falls Prevention and Management

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    Preventing Falls and Reducing Injury from Falls (3rd ed.) replaces the RNAO (2011) BPG Prevention of Falls and Fall Injuries in the Older Adult, which was originally published in 2002 and then revised in 2005 and 2011. Whereas previous editions focused on older adults in hospital and long-term-care settings, the scope of this third edition has been expanded to include in all adults (>18 years) at risk for falls and receiving care from nurses and other health-care providers across the health-care continuum, including those living in the community.

    The purpose of this guideline is to outline evidence-based approaches for preventing falls and reducing fall injuries for adults. Recommendations are provided at the following three levels:

    • Practice recommendations are directed primarily toward nurses who provide direct clinical care to adults at risk for falls across the continuum of care, including (but not limited to): primary care, home care, hospital care, and long-term care settings. The secondary audience of the practice recommendations includes other members of the interprofessional team who collaborate with nurses to provide comprehensive care. All of the recommendations are applicable to the scope of practice of registered nurses and nurse practitioners (general and extended classes); however, many are also applicable to other health-care providers.
    • Education recommendations are directed at individuals and organizations responsible for the education of healthcare providers, such as educators, quality improvement teams, managers, administrators, academic institutions, and professional organizations.
    • Organization and policy recommendations are directed at those managers, administrators, and policy-makers responsible for developing policy or securing the supports required within health-care organizations that enable the implementation of best practices. For optimal effectiveness, recommendations in these three areas should be implemented together.
    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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    Falls Gap Analysis

    An organizational assessment tool to assist with implementation and evaluation of the RNAO Prevention of Falls and Injury from Falls by comparing current practice to evidence-based practice.

    Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON, Canada. September 2017.

     

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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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    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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    A series of videos on Comfort Care Rounding (CCR) for the long term care sector developed through a partnership with Perley and Rideau Veteran’s Health Center and Struder Group Canada. The series includes morning round, the subsequent (sandwich) round, rounding in the evening/night, rounding on a resident with dementia, rounding with an independent resident, rounding: not just for PSWs, the rounding test scenario.

    Huron Consulting Group Inc. (n.d.). Comfort Care Rounding in Long-term care.  https://www.studergroup.com/resources/healthcare-tools/comfort-care-rounding

     

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    AThis 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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    The tool reviews the extrinsic and intrinsic risk factors for falls, as well as stratgeies for the development of a fall intervention program.

    Iowa Geriatric Education Center and University of Iowa. (n.d.). Fall Prevention. Retrieved from: http://www.healthcare.uiowa.edu/IGEC/publications/infoconnect

     

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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 Centre for Effective Practice developed a discussion guide and caregiver supplement which includes topics of assessment of fall prevention and prevention in relation to associated co-morbidities. This guide includes references to available relevant tools and services.

    Centre For Effective Practice. (2016). Falls Prevention Discussion Guide. Retrieved from https://cep.health/clinical-products/falls-preventon/#pc_page_1032

     

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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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    This online eLearning module provides the learner background information about causes and risk factors for falls. Reviews both extrinsic and intrinsic risk factors for falls, as well as the interdisipdisciplinary health care team that can be utilized to prevent falls in the geriatric population. Registration is required to access the eLearning Modules.

    RGPs of Ontario. (n.d.). Frailty e-Learning Module. [e-learning]. http://www.regionalhealthprogramsww.com/frailtymodules/register/

     

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    This handout describes why freezing occurs in Parkinson disease and how it increases a resident’s chances of falling. It provides 14 care-planning tips to help prevent freezing. Can be used for family or resident education on fall prevention as well as staff educational material.

    Parkinson Society Canada. (n.d.). Freezing. http://www.parkinson.ca/wp-content/uploads/2017/09/Freezing.pdf 

    Source: Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, BC

    Based on a fact sheet developed by Parkinson Society BC: reprinted with permission.

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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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    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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    Canadian Patient Safety Institute website contains tools and resources on Reducing Falls and Injury from Falls: Getting Started Kit. It contains clinical information on reducing falls and injuries from falls; and information on making improvements. Icons and resources to successfully implement interventions in an organization on best practices related to falls

    Canadian Patient Safety Institute. (n.d.). Reducing falls and injury from falls (falls): Getting started kit. http://www.patientsafetyinstitute.ca/en/toolsResources/Pages/Falls-resources-Getting-Started-Kit.aspx 

     

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    A summary of the recommendations of RNAOs Best Practice Guideline on Preventing Falls and Reducing Injury from Falls (3rd 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 is a resource manual for LTCHs on how to develop a successful person-centred Fall Prevention Program. It details and provides resources such as who should be members of the fall prevention team and their job descriptions, education modules for PSWs, registered staff and families, post fall risk assessments and documentation, environmental fall risk screening and a host of other QI tools.

    Taylor, J., Parmelee, P., Brown, H., & Ouslander,J. (2005). The Falls Management Program: A Quality Improvement Initiative for Nursing. https://www.ahrq.gov/sites/default/files/publications/files/fallspxmanual.pdf 

     

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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