• American Medical Directors Association (AMDA). Falls and fall risk. Columbia (MD): American Medical Directors Association (AMDA); 2003. 16 p. [1 reference]

This is the current release of the guideline.

This guideline updates a previous version: American Medical Directors Association (AMDA). Falls and fall risk. Columbia (MD): American Medical Directors Association (AMDA); 1998. 16 p.

• Falls
• Fall-related injuries
• Physical, functional, and environmental conditions that predispose patients to falls

Evaluation
Management
Prevention
Risk Assessment

Family Practice
Geriatrics
Internal Medicine

Advanced Practice Nurses
Allied Health Personnel
Dietitians
Health Care Providers
Nurses
Occupational Therapists
Pharmacists
Physical Therapists
Physician Assistants
Physicians
Social Workers
Speech-Language Pathologists

• To improve the quality of care delivered to patients in long-term care facilities who have a recent history of falls or who are at risk of falling
• To guide care decisions and to define roles and responsibilities of appropriate care staff

Elderly residents of long-term care facilities

Diagnosis/Assessment

1. Evaluation of history of falls
2. Assessment of risk of falls and post-fall evaluation (fall history, medications, underlying conditions, functional status, neurological status, psychological factors, environmental factors)
3. Work-up, as indicated, in patients with identified risk of falling
4. Evaluation and management of actual falls
5. Identification of nature, frequency, and causes of individual's falls
6. Identification of actual and potential complications of falls

Management/Treatment

1. Development of a plan for managing falls and fall risks
2. Management of the causes of falling (e.g., implementing restorative or rehabilitative care to improve strength, balance, gait, and transferring ability; educating regarding managing orthostatic hypotension; evaluating and managing medication use)
3. Implementation of relevant general measures to address falling and fall risks (e.g., facility approaches, exercise and balance training, use of physical restraints, use of alarms, environmental modifications)
4. Management of factors that may cause serious consequences of falling
5. Monitoring of falling in individuals with fall risk or fall history
6. Conducting quality improvement activities related to falls

• Risk, frequency, and incidence of falls and fall-related injuries
• Morbidity and mortality related to falls
• Other measures, such as patient and family satisfaction, use of physical restraints, and quality of life

Searches of Electronic Databases

Not stated

Not stated

Expert Consensus

Not applicable

Review

Not stated

Expert Consensus

Interdisciplinary workgroups developed the guidelines, using a process that combined evidence and consensus-based approaches. Workgroups included practitioners and others involved in patient care in long-term care facilities. Beginning with a general guideline developed by an agency, association, or organization such as the Agency for Healthcare Research and Quality (AHRQ), pertinent articles and information, and a draft outline, each group worked to make a concise, usable guideline tailored to the long-term care setting. Because scientific research in the long-term care population is limited, many recommendations were based on the expert opinion of practitioners in the field.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

All American Medical Directors Association (AMDA) clinical practice guidelines undergo external review. The draft guideline is sent to approximately 175+ reviewers. These reviewers include AMDA physician members and independent physicians, specialists, and organizations that are knowledgeable of the guideline topic and the long-term care setting.

The guideline was developed by an interdisciplinary work group using a process that combined evidence- and consensus-based thinking.

• Guideline implementation is intended to minimize fall risk and risk of fall-related injuries while maximizing individual dignity, freedom, and quality of life.
• Although no specific efforts or combinations of interventions have been shown to prevent all falls or injuries associated with falling, it is often possible to reduce the frequency of falls and the severity of injuries associated with falling.

Not stated

• This clinical practice guideline is provided for discussion and educational purposes only and should not be used or in any way relied upon without consultation with and supervision of a qualified physician based on the case history and medical condition of a particular patient. The American Medical Directors Association and the American Health Care Association, their heirs, executors, administrators, successors, and assigns hereby disclaim any and all liability for damages of whatever kind resulting from the use, negligent or otherwise, of this clinical practice guideline.
• The utilization of the American Medical Director Association's Clinical Practice Guideline does not preclude compliance with State and Federal regulation as well as facility policies and procedures. They are not substitutes for the experience and judgment of clinicians and care-givers. The Clinical Practice Guidelines are not to be considered as standards of care but are developed to enhance the clinician’s ability to practice.

The implementation of this clinical practice guideline (CPG) is outlined in four phases. Each phase presents a series of steps, which should be carried out in the process of implementing the practices presented in this guideline. Each phase is summarized below.

1. Recognition
   • Define the area of improvement and determine if there is a CPG available for the defined area. Then evaluate the pertinence and feasibility of implementing the CPG.
2. Assessment
   • Define the functions necessary for implementation and then educate and train staff. Assess and document performance and outcome indicators and then develop a system to measure outcomes.
3. Implementation
   • Identify and document how each step of the CPG will be carried out and develop an implementation timetable.
   • Identify individual responsible for each step of the CPG.
   • Identify support systems that impact the direct care.
   • Educate and train appropriate individuals in specific CPG implementation and then implement the CPG.
4. Monitoring
   • Evaluate performance based on relevant indicators and identify areas for improvement.
   • Evaluate the predefined performance measures and obtain and provide feedback.

Examples of Process Indicators Related to Falls

• Is a fall risk assessment completed and documented for each newly admitted patient? Are the results of this assessment communicated to the patient and his or her family or advocate?
• Do practitioners address medical or medication risk factors in patients who are identified as having such risk factors?
• Does a practitioner review the case of any patient who falls more than once, or who has a fall with a significant injury, to identify potentially correctable conditions?
• Do facility staff and management review the factors (e.g., environment, staff assignments, time of day) associated with falls?

Getting Better
Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness
Safety

• American Medical Directors Association (AMDA). Falls and fall risk. Columbia (MD): American Medical Directors Association (AMDA); 2003. 16 p. [1 reference]

Not applicable: The guideline was not adapted from another source.

2003

American Medical Directors Association - Professional Association

American Medical Directors Association

Steering Committee

Not stated

Not stated

This is the current release of the guideline.

This guideline updates a previous version: American Medical Directors Association (AMDA). Falls and fall risk. Columbia (MD): American Medical Directors Association (AMDA); 1998. 16 p.

None available

This NGC summary was completed by ECRI on July 6, 2004. The information was verified by the guideline developer on August 4, 2004.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. For more information, please contact the American Medical Directors Association (AMDA) at (800) 876-2632.