Elderly/Long-term Care

Incident reporting system helps gather information that can reduce falls by nursing home residents

A structured questionnaire that helps nursing home staff document falls by residents can improve the quality of fall documentation and subsequent safety analysis to identify correctable factors that increase fall risk. That is the conclusion of a study that compared incident reporting of resident falls in three nursing homes using a structured reporting system (the intervention group) with three nursing homes that continued using their existing narrative incident reporting process to document falls (the control group).

Laura Wagner, Ph.D., R.N., of the Baycrest Centre for Geriatric Care, and colleagues collected fall-related information from the medical records of 207 residents in the 6 nursing homes, who fell and met the eligibility criteria (age 65 years or older, not in a coma, and not receiving hospice services). The intervention group (104 residents) included significantly more older, female, and black residents than did the control group (103 residents), and more of them had physical restraints.

Auditing of the medical records for both groups of nursing home residents revealed significantly greater documentation of fall diagnosis, management, and monitoring in the nursing homes using the structured questionnaire than in the control nursing homes. These results were also true for residents who had fallen within 6 months of the beginning of the study period, and fell again during the study (47 in the intervention group and 43 in the control group).

Based on their findings, the researchers suggest that the use of paper or electronic systematic assessment forms can capture readily available information about a resident's fall that may not be included in a narrative record. Nursing homes using a structured questionnaire could also use the information to measure staff compliance with policies related to fall assessment, and to measure the success of specific fall interventions (such as bed alarms) by identifying a reduced number of falls associated with their use. The study was funded in part by the Agency for Healthcare Research and Quality (HS14663).

More details are in "Use of a falls incident reporting system to improve care process documentation in nursing homes," by Dr. Wagner, Elizabeth Capezuti, Ph.D., R.N., Patricia C. Clark, Ph.D., R.N., and others, in the April 2008 Quality and Safety in Health Care 17(2), pp. 104-108.

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