Table 2 FALLS protocol activities, rationale, who is involved and time required

FALLS Coordinator and Team Role

Training Session

Researcher reviews: 1) role of FALLS Coordinator and Team members; 2) Falls Management Program rationale and main components; 3) annotated slide presentation on practical aspects of fall prevention; 4) toolkit materials; 5) study expectations.

Falls Team members champion fall prevention, identify area to improve, monitor changes.

FALLS Coordinator, Falls Team, DON

1, 4 hrs session

Weekly FALLS Team teleconference

Researcher contacts FALLS team weekly during 3-month intervention for problem-solving/discussion, and highlights a topic from the Fall Management Program in more depth. Topics include 1) staff fall prevention education; 2) medications and falls 3) patient and family fall education; 4) orthostatic hypotension; 5) vision assessment and intervention; 6) gait and balance assessment and intervention 7) environmental assessment and intervention; 8)challenging behavior management; 9) establishing a culture of safety; 10) audit and feedback; and 11) Wrap-up and re-setting goals

Reinforces key concepts of multi-factorial risk reduction, supports FALLS Coordinator and maintains enthusiasm.

FALLS Coordinator, and any other team members s/he wishes

11, 30 min sessions weekly

(5.5 hrs total)

Staff Education

Case-Based Modules (online and paper form)

Nurse module. Covers impact, fall risk factor assessment and intervention focusing on orthostatics, gait, toileting, medications, environmental hazards.

NA module. Covers fall risk factor identification and intervention focusing on gait, footwear, toileting, hip protectors, and environmental hazards.

Prescriber/pharmacist module. Covers epidemiology/impact, risk factor assessment, risk factor reduction focusing on psychotropic medication reduction and Vitamin D.

Uses case-based learning to impart knowledge and change attitudes about multi-factorial fall risk reduction.

RNs, LPNs, NAs, MDs, NPs, PAs, Consultant Pharmacists and others (PT, SW, Activities etc)

30-60 min

Post-Fall Problem-solving

Academic Detailing

Nursing home frontline staff is invited to participate in consultations with the researcher and FALLS Coordinator regarding their most challenging residents with falls, modeling risk factor assessment and multi-factorial interventions. Sessions occur at each nursing station during the day and evening shifts.

Reinforces key concepts and promotes behavior change and interdisciplinary discussions [75].

Nurses, NAs, other interested staff

2, 20 min sessions

(40 min total)

Audit and Feedback

Feedback Report

Report uses visual (bar graph) and written depictions of the nursing home's current practice on fall-related process and outcome measures, and how this compares with peer nursing homes. Researcher presents and explains the feedback report to FALLS Team.

Identifies areas for improvement, promotes behavior change [75].

FALLS team, others as desired by Falls Coordinator

30 min

Toolbox

Morse Fall Scale: Validated scale that quantifies fall risk in nursing home residents; Nurse Fall Risk Reduction Worksheet: Prompts nurse to identify and modify reversible fall risk factors. Can be used for chart documentation; Prescriber/Pharmacist Medication Reduction Worksheet: Prompts consideration of dose reduction or discontinuation of high fall-risk medications, including lower risk substitution options; Environmental Checklist: Facilitates identification of hazards in resident room, bathroom, and common areas; Wheelchair maintenance log and stickers: Facilitates regular assessment and repair of wheelchair brakes; Fall Risk Fax Communication Form: Allows nurse/pharmacist to communicate concerns about medications with prescribers; Patient and Family Brochure: Describes interventions that the nursing home is using to reduce falls; Physician/Prescriber Brochure: Describes the fall reduction program and encourages review of medication reduction worksheets and faxes.

Provides modifiable tools to assist with communication, implementation, and documentation of multi-factorial risk reduction.

FALLS Coordinator determines dissemination

Voluntary