Prevention/Care Management, 2006

Beverly Health and Rehabilitation Services, Inc.

February 2006

Beverly Health and Rehabilitation Services, Inc. (BHRS), one of the nation's leading providers of long-term care, is using components of a program to prevent falls developed by AHRQ grantees as part of its efforts to reduce injury-causing falls. With 345 skilled nursing centers and 18 assisted living facilities in 24 states, BHRS provides care to approximately 35,000 residents.

Influenced by the research of AHRQ grantee, Joseph G. Ouslander, and colleagues at Emory University, BHRS developed an early intervention program designed around the goal of creating a culture in which fall prevention is the responsibility of everyone involved with a resident. An interdisciplinary team that includes nursing, rehabilitation, dietary, and maintenance staff forms the framework of the program. In addition, each BHRS facility has a fall-risk committee consisting of interdisciplinary team members.

Ongoing AHRQ-funded research shows that implementation of the program is feasible, improves care process documentation, and may reduce falls even in the face of substantial reduction in the use of restraints, a major emphasis of the federal government. The study addressed several factors that can play an important role in medical errors and patient injuries in long-term care facilities, including the following: lack of education among staff and primary care providers on risk factors for patient injuries; lack of effective tools that facilitate documentation and communication; and sub-optimal use of information systems.

Previous data collection had shown BHRS administrators that half of the residents had only one fall and most falls occurred in the resident's room during the second shift. In addition, most falls occurred within the first few weeks of admission. Initial evaluation of internal data by BHRS researchers confirmed the key predictors of falls in this setting, which appeared to mirror AHRQ/Emory research findings. A teleconference with AHRQ and the Emory team was held to discuss their program and research, which provided further insight and guidance in designing the falls management program at BHRS.

The Emory program showed that a safety inspection and space inspection significantly reduced falls. At BHRS, these inspections will be done upon admission. The space inspection insures that, for example, the room is arranged so that a stroke patient's bed is optimally positioned for transfers in and out of bed. The engineering inspection checks for such things as properly functioning equipment and sufficient lighting.

Upon admission, each new resident is assessed for risk of falling by the nursing staff. Nurses then implement a "Falls Toolbox" that includes, among other items, bed alarms and hipsters (protective padding worn under clothes). A universal alert communication system is used that consists of tags placed in prominent places to warn staff and others that the patient is at risk for falls. The interdisciplinary team meets daily, and any residents who have fallen during the previous 24 hours are discussed with patient care plans, which are updated as appropriate.

Approximately 100 nurse consultants will be trained by headquarters staff. They, in turn, will train staff at each of the facilities for which they are responsible. The training will include a Power Point presentation and Webcast that will utilize information from the following key sources:

1. BHRS's Corporate Fall-Management Committee.
2. BHRS's own internal research.
3. Emory research, adapted to the particular needs of BHRS.

Training on medications and dietary needs will be included.

Falls information will be part of the annual continuing competency requirements for staff at all facilities and a requirement of all new employees. BHRS is also upgrading and enhancing its computer software so that the information on falls will be more useful and give consistency in documentation.

The Emory Center on Health Outcomes and Quality is a partner within AHRQ's Integrated Delivery System Research Network (IDSRN).

Impact Case Study Identifier: CDOM 06-04
AHRQ-Sponsored Activity: Research
Topic(s): Long-Term Care
Scope: National

Taylor JA, Parmelee P, Brown H, Strothers HS, Ouslander JG. A model program for the management of falls in long-term care facilities. (Submitted for journal consideration.) (HS11588)

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