Implementing best practices in falls prevention
Numerous studies demonstrate that falls are a leading cause of injury-related hospitalizations among long-term care residents. Half of all long-term care residents experience at least one fall each year, for instance – nearly the double the rate for older adults who live independently.
A long list of factors can contribute to falls – everything from environmental hazards to declines in physical and cognitive status. Further complicating efforts to prevent falls in long-term care homes are high rates of turnover among residents and staff, and the need to respect the autonomy of residents.
In 2016, Ottawa’s Perley Health long-term care home qualified as a Best Practices Spotlight Organization (BPSO), a collaborative program led by the Registered Nurses Association of Ontario. Implementing RNAO’s best practices in falls prevention was among the home’s first BPSO projects.
Perley Health began a comprehensive initiative to minimize resident falls, engaging everyone from nurses and personal support workers to occupational therapists, physiotherapists, housekeepers, and more. Many actions were proposed and analyzed, and the most promising ones – such as risk assessments and post-fall staff huddles – have been standardized and implemented.
Among the most successful has been comfort care rounding (CCR), a multi-step process that has staff check regularly on each resident, scan for potential risks and log the results.
In the units where CCR was piloted, the rates of falls initially declined by as much as 50%. The rates subsequently increased, although they remain relatively low. In response. Perley launched another initiative designed to remind frontline staff of how best to respond when a resident falls.
Daniela Acosta is Manager of Education and Knowledge Translation and was the initial lead for the BPSO. “While all our frontline staff are trained in how to respond, proper procedures are sometimes not followed in the heat of the moment,” she says. “Studies show that simulation-based training can be an effective reminder.”
Along with a colleague, Acosta designed and delivered a series of 30-minute workshops to frontline staff. Each workshop featured a simulated fall, a debriefing and a survey. The rates of falls declined again for a short period. Overall, fall rates declined from 23% in 2017 to 16% in 2024.
Perley Health delivers a modified version of the simulation-based training as part of its orientation for newly hired nurses and plans to scale up the program this fall.
“Quality improvement is an ongoing journey,” says Acosta. “You try something new, analyze the results and adopt practices that are proven effective. Then you start the cycle all over again.”
