BEST EVIDENCE FOR
PREVENTING FALLS IN
THE RESIDENTIAL CARE
SETTING
Lindsay Grissett
Amy Long
Samantha McDowell
INTRODUCTION
• Residents in a Nursing Home setting are among the most
susceptible for falls. This is a concern for the residents, their
families, and the staff.
• According the the U.S. Department of Health and Human Services,
each year roughly 1800 people living in nursing homes die from
sustaining falls (Agency for Healthcare Research and Quality,
2013).
• These residents typically suffer from multiple disease processes to
include increased muscle weakness, multiple medication uses, and
decreased memory.
INTRODUCTION (CONT.)
MEMORY
LOSS
• SHORT TERM
• LONG TERM
• BOTH
DECREASED
COGNITIVE
SKILLS
POOR DECISOIN
MAKING SKILLS
FALLS
INTRODUCTION (CONT.)
Residents are usually repeat fallers, and
will average around 2.6 falls per year
with 6% sustaining fractures (Agency for
Healthcare Research and Quality, 2013).
CASE STUDY
• Tiger Terrace Skilled Nursing Facility houses 140 residents, with
the majority being ambulatory and having cognitive deficits.
• The majority of the nursing staff are Licensed Practical Nurses
(LPN).
• Tiger Terrace has witnessed a drastic increase in falls over the past
six months with many of the residents sustaining hip fractures.
• A team consisting of the Director of Nursing (DON), the Assistant
Director of Nursing, (ADON), one Registered Nurse (RN)
Supervisor, and one LPN assembled in order to research the best
falls prevention program in a skilled nursing facility.
SITUATION FOCUSED QUESTION
• The purpose and goal of this query is to identify a
falls prevention program that has been reported as
successful in decreasing the number of falls in the
nursing home setting where many of the residents
have impaired cognition.
FOCUS QUESTION
The focused question is “What is the highest evidence
related to a falls prevention program, that is effective in
preventing falls in ambulatory residents with impaired
cognition, living in a Skilled Nursing Facility?”
TARGET RESOURCES
• Various systematic reviews were used to obtain the highest
evidence available.
• Articles were examined for relevance.
• Information that was specific to falls in the nursing home
setting where residents had altered levels of cognition was of
highest priority.
• Goals were set to obtain information containing current data.
THE SEARCH
•The team utilized the
focused question to
help guide the search.
•The PPAARE method
was used to create
the focused question.
PPAARE
PPAARE Component
Case Example
Problem
Increase in falls
Patient
Ambulatory residents in a skilled nursing
facility who are cognitively impaired.
Action
Falls prevention program
Alternative
Not applicable
Patient Results
Decrease the number of falls in the facility.
Level of Evidence
Highest level of evidence.
RELEVANT EVIDENCE
• Although nine different sources of information were identified, only
5 were chosen due to relevance related to the PPAARE.
• The chosen studies were conducted in the last five years and
provided tables that listed cause and effect, as well as statistics
necessary to guide the development of a falls prevention program.
Falls can be labeled as having causes that are Intrinsic or Extrinsic.
Intrinsic- Meaning they are related to factors related to the patient,
such as medication.
Extrinsic- Meaning they are related to external factors such as a wet
floor.
INFORMATION THAT WAS FOUND
• FALLS COST RESIDENTS MENTAL WELL
BEING AS WELL AS PHYSCIAL WELL
BEING, ASIDE FROM MONETARY COSTS.
• HAVING A WELL INFORMED STAFF IS
PERTINENT.
• THERE IS A NEED TO IMPROVE
DOCUMENTION.
• THE IMPORTANCE OF USING A FALLS
ASSESSMENT TOOL WAS STRESSED.
• A GOLD STANDARD FOR FALL
ASSESSMENT TOOLS HAS NOT YET BEEN
DEVELOPED.
INFORMATION FOUND
• DATA GATHERING WAS FOUND TO BE OF
HIGH IMPORTANCE CONCERNING
IDENTIFYING RESIDENTS AT RISK
• QUALITY OF LIFE DECREASES FOR
RESIDENTS AFTER A FALL
• STUDIES HAVE BEEN DONE USING
LAVENDER, WHICH HAS A CALMING
EFFECT AND HELPS WITH BEHAVIOR
ISSUES.
• STUDIES WERE DONE CONCERNING A
FULL TIME NURSE TO ASSIST WITH EBP
IN THE LONG-TERM CARE SETTING.
EVIDENCE APPRAISAL
Quantitative Study
Study appraised concerned using lavender with olfactory
stimulation.
• Study found to be strong.
• Focused on generalized population of residents 65
and older.
• Data measured consistently over one year period.
• Funding for the study was unbiased.
EVIDENCE APPRAISAL
Qualitative Study
The study appraised concerned using a Falls Risk Assessment
(FRA) tool.
•
•
•
•
A multi-disciplinary team approach was used in the study.
There were no conflict of interest.
Interpretation of data used was consistent with actual data.
Self-disclosure was made evident.
WHAT DID WE LEARN?
CHARTING AND
DOCUMENTATION
NEEDS TO IMPROVE
ASSESSMENTS
SHOULD TAKE PLACE
AT BEDSIDE
EVERY PATIENT
SHOULD BE
ASSESSED ON
ADMISSION
WHAT DID WE LEARN?
• ASSESSMENT TOOLS ARE ONLY GOOD
IF THEY ARE USED PROPERLY
• LAVENDER MAY HAVE AN EFFECT
DECREASING ANXIETY IN RESIDENTS
WHICH CAN LEAD TO FALLS
• STUDIES AND RESEARCH IS A
CONTINUING PROCESS TO FIND
ANSWERS TO THE PROBLEM OF FALLS
IN THE NURSING HOME SETTING.
RESOURCES
Lea, E., Andrews, S., Hill, K., Haines, T., Nitz, J., Haralambous, B., Moore, K., & Robinson, A.
(2012). Beyond the ‘tick and flick’: Facilitating best practice falls prevention through
an action research approach. Journal of Clinical Nursing, 21, 1896-1905. doi: 110.1111/
J.1365-2702.2012.04121.x
Sakamoto, Y., Ebihara, S., Ebihara, T., Tomita, N., Toba, K., Freeman, S., Arai, H., &
Kohzuki, M. (2012). Fall prevention using olfactory stimulation with lavender odor
in elderly nursing home residents: A randomized controlled trial. Journal of the
American Geriatrics Society, 60, 1005-1011. doi: 10.1111/j.1532-5415.2012.03977.x
U.S. Department of Health and Human Services, (2013). Interdisciplinary team identifies
and addresses risk factors for falls among nursing home residents, leading to fewer
falls and less use of restraints. Retrieved from Agency for Healthcare Research and
Quality website: http://www.innovations.ahrq.gov/content.aspx?id=1835