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Falls and falls injury prevention activity audit for residential aged care facilities

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Falls and falls injury prevention activity audit for residential aged care facilities National Ageing Research Institute October This tool is based on a tool that was originally
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Falls and falls injury prevention activity audit for residential aged care facilities National Ageing Research Institute October This tool is based on a tool that was originally developed by the National Ageing Research Institute and Word Design Interactive for the Victorian Quality Council (2004) Minimising the Risk of Falls & Fall-related Injuries Guidelines Pack. It was modified for use in the Star Falls Prevention project that was funded through the Australian Government Department of Health and Ageing s Enhancing Better Practice in Residential Aged Care Program (2009). Aim of the audit tool This tool has been designed to assist residential aged care facilities to reflect on their current practice in relation to evidence based falls prevention. The audit can be used to identify areas for improvement and to inform quality improvement activities. Completing the audit tool The tool would normally be completed by nursing and/or management staff who are aware of various policies and practices within the facility. Some parts of the tool may also require discussions with other staff working in the facility to determine whether practice reflects policies. The audit tool can be used intermittently to gauge change over time and to ensure gaps in evidence based practice are identified and addressed. If you are completing the tool electronically, the check boxes can be filled automatically by double clicking on the text box. A screen will appear and the default value of not checked will be selected. Click on checked and then OK to place a cross in the box. Outline of the audit tool The following falls and injury prevention topics are covered in the audit tool: Section 1: Falls risk screening... 3 Section 2: Falls risk assessment... 5 Section 3: Falls and falls injury prevention interventions... 8 Section 4: Falls incident monitoring processes Section 5: Environmental audits Section 6: Organisational support for falls / falls injury prevention activity Section 7: Falls and falls injury prevention staff training Section 8: Falls and falls injury prevention information for residents Section 9: Monitoring falls / falls injury prevention activities Section 10: Other falls / falls injury prevention activities Falls and falls injury prevention activity audit for residential aged care facilities, October Section 1: Falls risk screening Falls risk screening refers to a brief (often less than 5 item) check to determine a resident s risk of falling. It is usually used to identify residents who need to have a more detailed assessment of falls risk carried out. There is no evidence to indicate that a screen should or should not be conducted in residential care. However, guidelines for falls prevention recommend that for high risk groups, such as the majority of residents in residential care facilities, a full assessment should be conducted, rather than a screening process, as the screening process is likely to classify most residents at high risk and therefore require a detailed falls risk assessment (see section 2 on Falls risk assessment). 1. Does your facility currently use a falls risk screening tool to identify residents who are at high risk of falling and require in-depth risk assessment? (go to Section 2) If yes, can you please attach a copy of the tool? 2. When is the tool completed (please tick all that apply)? on admission daily or more often weekly monthly after a fall or other incident other (please specify) 3. Has the falls risk screening process and tool used by your facility been reviewed or updated in the past two years? If yes, please provide details. 4. Has the accuracy of the falls risk screening tool in classifying resident s level of risk been assessed in the past? If yes, please provide details. Falls and falls injury prevention activity audit for residential aged care facilities, October 5. Has your facility audited completion of the falls risk screening tool in the past two years? If yes, please provide details, outcomes and any actions as a result of the audit. 6. Is your falls risk screening tool used in other parts of the organisation? If yes, please provide details of what parts of your organisation use it. 7. Please add any other information about your falls risk screening tool or risk screening process you consider relevant. Falls and falls injury prevention activity audit for residential aged care facilities, October Section 2: Falls risk assessment Falls risk assessment is a systematic comprehensive process to identify an individual resident s risk factors for falling. Detailed falls risk assessment has been used as part of multi-factorial falls prevention studies that have been shown to reduce falls in residential care facilities. They are recommended as a core part of falls prevention guidelines in residential care facilities. 1. Does your facility currently use a falls risk assessment tool? If yes, can you please attach a copy of the tool? 2. When is the tool completed (please tick all that apply)? on admission daily or more often weekly monthly after a fall or other incident after a change in a resident s health status following a change in environment (e.g. post hospital admission) other (please specify) 3. Who is the falls risk assessment tool completed by? only one discipline completes the entire form (e.g. only ever completed by nursing staff) (please specify which discipline completes the form) any discipline completes the entire form (e.g. any person from any discipline can complete the form but they complete the entire form) (please specify which disciplines may complete the form) a multi-disciplinary team completes the form (e.g. one section is completed by nursing staff, one section by physiotherapists, one section by a doctor, etc) (please specify which disciplines complete the form) other (please specify) Falls and falls injury prevention activity audit for residential aged care facilities, October 4. Please select, from the list below, the risk factors asked about on your risk assessment tool: leg muscle weakness and deconditioning poor balance and unsteadiness in walking medicines cognitive impairment postural (orthostatic) hypotension incontinence sensory loss ( vision, somatosensory, vestibular, hearing) feet and footwear problems fear of falling inadequate nutrition history of previous falls other (please specify) 5. Has the falls risk assessment process and tool used by your facility been reviewed or updated in the past two years? If yes, please provide details. 6. Has the accuracy of the falls risk assessment tool in classifying resident s level of falls risk been assessed in the past? If yes, please provide details. 7. Has your facility audited completion of the falls risk assessment tool in the past two years? If yes, please provide details, outcomes and any actions as a result of the audit. Falls and falls injury prevention activity audit for residential aged care facilities, October 8. Is your falls risk assessment tool used in other parts of the organisation? If yes, please provide details of what parts of your organisation use it. 9. Please add any other information about your falls risk assessment tool you consider relevant. Falls and falls injury prevention activity audit for residential aged care facilities, October Section 3: Falls and falls injury prevention interventions A range of single and combined falls prevention interventions have been shown to reduce falls in residential care facilities. Guidelines recommend combinations of the interventions listed in this section (below). 1. What processes are used to facilitate staff decision making about falls / falls injury prevention interventions when an individual has been identified at increased risk of falling (tick more than one if appropriate)? risk assessment form completed / reviewed resident s risk discussed at team meeting / handover checklist of risk factors and interventions referred to resident s falls risk discussed with general practitioner / other health professional (e.g. physiotherapist) other (please specify) 2. Are the strategies that are implemented aimed to address each modifiable risk factor that is identified on a resident s risk assessment tool? 3. Please select the falls prevention interventions (from the selection below) that are available in your facility: a) Group exercise (if selected please provide more information about the intervention below by completing i, ii, iii, iv, v & vi) i) How often are the group exercises run each week? ii) How long is each of the group exercise sessions (minutes)? iii) What proportion of residents participate in the group exercise programs? iv) Who leads the group (e.g. physiotherapist, activities leader)? v) What type of exercises are used (please tick all that apply)? standing seated some standing, some sitting flexibility exercises balance exercises resistance or weight exercises walking / fitness exercises other (please specify) vi) Please add any other information about your group exercise programs you consider relevant. Falls and falls injury prevention activity audit for residential aged care facilities, October b) Individual exercise (if selected please provide more information about the intervention below by completing i, ii, iii, iv, v & vi) i) What proportion of residents are prescribed an individual exercise program? ii) Who prescribes the individual exercise program (e.g. physiotherapist, activities leader)? iii) Who implements the individual exercise program with the resident? physiotherapist activities leader nursing staff personal care staff other (please specify) iv) What is the average duration (minutes) and frequency (days/week) that the individual exercise program is run? v) What type of exercises are used (please tick all that apply)? standing seated some standing, some sitting flexibility exercises balance exercises resistance or weight exercises walking / fitness exercises other (please specify) vi) Please add any other information about your individual exercise programs you consider relevant. c) Walking aids (if selected please provide more information about the intervention below by completing i, ii, iii, iv & v) i) Who prescribes new or changes to walking aids (e.g. physiotherapist)? ii) What types of walking aids are used in your facility (e.g. single point sticks, wheelie frames)? iii) Of the residents in your facility who are mobile, what proportion use a walking aid? iv) Is there a regular maintenance program for the walking aids used in your facility (e.g. review of stoppers on sticks and frames)? If yes, please provide details: Falls and falls injury prevention activity audit for residential aged care facilities, October v) Please add any other information about the use of walking aids in your facility you consider relevant. d) Hip protectors (if selected please provide more information about the intervention below by completing i, ii, iii, iv & v) i) What proportion of residents in your facility use hip protectors? ii) Who or what determines which residents are provided with hip protectors? iii) What kind of hip protectors are used in your facility (brand, type)? iv) What is the compliance rate with residents wearing their hip protectors (i.e. what proportion of those recommended to use them actually do wear them)? v) Please add any other information about the use of hip protectors in your facility you consider relevant. e) Medicine review (if selected please provide more information about the intervention below by completing i, ii & iii) i) Who does the medicine review (e.g. GP, pharmacist)? ii) When are medicine reviews done? on a regular basis (e.g. weekly, fortnightly) when it is identified as necessary following a falls risk assessment when there is a change in the resident s condition other (please specify) iii) Please add any other information about medicine reviews in your facility you consider relevant. Falls and falls injury prevention activity audit for residential aged care facilities, October f) Vitamin D and calcium supplementation (if selected please provide more information about the intervention below by completing i, ii, iii & iv) i) What proportion of residents take vitamin D and/or calcium supplements? Vitamin D: % Calcium: % Vitamin D & Calcium: % ii) When are residents vitamin D and/or calcium levels monitored and reviewed? on a regular basis (e.g. weekly, fortnightly) when it is identified as necessary following a falls risk assessment when there is a change in the resident s condition other (please specify) iii) Are other strategies to improve vitamin D levels in residents used with the facility (e.g. increased sunlight exposure for 20 minutes per day outside of peak sun times)? If yes, please provide details: iv) Please add any other information about vitamin D and/or calcium supplementation in your facility you consider relevant. g) Toileting assistance program (to address continence issues) (if selected please provide more information about the intervention below by completing i, ii & iii) i) What type of toileting assistance program is used in your facility? timed voiding program (a fixed schedule of toileting) habit retraining (identifying a pattern of voiding and individualising the toileting schedule) prompted voiding program (increasing a person s ability to discriminate their continence status and to respond appropriately) other (please specify) ii) Who is responsible for implementing the toileting assistance program with the residents? iii) Please explain how the toileting assistance program works in your facility? Falls and falls injury prevention activity audit for residential aged care facilities, October v) Please add any other information about the toileting assistance program in your facility you consider relevant. h) Adequate condition and use of aids for sensory loss (e.g. glasses appropriate and used correctly, hearing aids appropriate and used correctly) (if selected please provide more information about the intervention below by completing i, ii & iii) i) Who is responsible for ensuring that sensory aids are appropriate for the resident, being used correctly and are in good working order? ii) Is there a regular review process for sensory aids to ensure that they are always in good working order? If yes, please provide details: iii) Please add any other information about the maintenance and use of sensory aids in your facility you consider relevant. i) Feet in good condition and appropriate footwear (if selected please provide more information about the intervention below by completing i, ii & iii) i) Does a podiatrist regularly check resident s feet and footwear? If yes, please indicate frequency of review: fortnightly monthly bi-monthly six monthly annually other (please specify) ii) If it is recommended that a resident requires new footwear, what is the process for this? iii) Please add any other information about ensuring residents have good feet and footwear in your facility you consider relevant. Falls and falls injury prevention activity audit for residential aged care facilities, October j) Surveillance (if selected please provide more information about the intervention below by completing i, ii, iii, iv & v) i) What forms of surveillance are used in your facility? locate at risk residents closer to nurses station bed / chair alarms sitters flagging those at high risk with indicator (e.g. coloured sticker above bed) other (please specify) ii) If you use a bed / chair alarm, what type and model do you use? iii) If you use a sitter, who undertakes this role and how long do they do it for? iv) If you use an indicator to flag residents at high risk, what do you use and where is it located (e.g. above resident s bed, on resident s case notes)? v) Please add any other information about surveillance options used in your facility you consider relevant. k) Hi-lo or lo-lo beds (if selected please provide more information about the intervention below by completing i, ii, iii & iv) i) What proportion of residents in your facility use hi-lo or lo-lo beds? ii) Who or what determines which residents are provided with hi-lo or lo-lo beds? iii) What kind of hi-lo or lo-lo beds are used in your facility (brand, type)? iv) Please add any other information about the use of hi-lo or lo-lo beds in your facility you consider relevant. Falls and falls injury prevention activity audit for residential aged care facilities, October l) Referral to other health professionals (e.g. physiotherapist, occupational therapist, podiatrist, doctor, psychologist, dietitian) (if selected please provide more information about the intervention below by completing i, ii & iii) i) What health professionals are available to refer to (please tick all that apply)? physiotherapist psychologist dietitian general practitioner pharmacist occupational therapist podiatrist geriatrician psycho-geriatrician other (please specify) ii) What process is followed when referring residents to health professionals? iii) Please add any other information about the referral process in your facility you consider relevant. m) Other health professionals (please specify and provide details on the intervention below by completing i) i) How many hours per month does your facility have routinely available for each of the following disciplines (please indicate hours next to each discipline you have in your facility)? Dietitian hours per month General practitioner hours per month Geriatrician hours per month Occupational therapist hours per month Pharmacist hours per month Physiotherapist hours per month Podiatrist hours per month Psycho-geriatrician hours per month Psychologist hours per month Other (please specify) Falls and falls injury prevention activity audit for residential aged care facilities, October n) Other (please specify and provide details on the intervention) 4. What processes are used to communicate to other staff about falls / falls injury prevention interventions that are being / have been implemented (tick all that apply)? team meeting / handover client notes / file care plan falls prevention risk assessment sheet other (please specify) 5. Has the process used to implement falls / falls injury prevention interventions been reviewed in the past? If yes, please provide details. 6. Do the processes used to implement falls/falls injury prevention interventions appear to be working well in your facility? Please provide details of why or why not. Falls and falls injury prevention activity audit for residential aged care facilities, October Section 4: Falls incident monitoring processes Guidelines recommend that a standard definition of a fall should be used by an organisation to determine whether an incident is to be regarded as a fall. All falls should be systematically documented in the organisation s incident reporting system. 1. Does your facility use a standard definition for a fall? If yes, please provide the definition: 2. How are resident fall incidents documented in your facility? General Incident Report form (paper based) Falls Incident Report form (paper based) Computerised Incident Reporting System (please specify what system you use) Client notes / file Other (please specify) If a paper based form is used please attach a copy 3a. If your facility has a paper based incident reporting system, what happens to the completed incident forms (please tick all that apply)? Paper based copies are sent to administration Data is collated and reported back to nurse unit manager Data is collated and reported back to staff intermittently Data is collated, reported back to nurse unit manager and then to staff routinely Other (please specify) 3b. If your facility has a computer based incident reporting system, what happens to the completed incident forms (please tick all that apply)? Data is collated and reported back to nurse unit manager Data is collated and reported back to staff intermittently Data is collated, reported back to nurse unit
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