AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention Implementation Materials Training Handout 3: Meeting Descriptions and Suggested Falls Reports Quarterly Monthly Summary of Falls Fall Risk Nursing Factors by Factors Postfall Home Typical Attendees Unit or by Unit or Meetings Meeting Description and Leads Report Facility Facility Summary Care Plan Weekly review of resident Multidisciplinary team X X Meetings care plans. Reports help care plan change decisions. DON or ADON typically leads the meeting. CNA Shift CNAs meet at shift change Charge nurse/nurse X Change to share summary of manager and CNAs Report clinical status and residents’ care plan Charge nurse or residents’ interventions for CNA nurse manager followup. The charge nurse typically leads the typically generates the meeting. reports for the CNA staff at the beginning of the shift to identify residents with changes in risk. Nurse Shift Nurses meet at change of Nurse managers or X Change shift to review resident charge nurses Report clinical and risk status. Risk reports help Nurse managers or identify residents at risk for charge nurses falls that need attention. typically lead the meeting. Quality The QI Committee may use QI Committee, X X Improvement the reports to identify risk department heads, Review factors most commonly including associated with falls in administrator and order to help identify medical director (or facilitywide or unit-level physician/ANP performance improvement designee) projects that may be Nursing or QI director needed to mitigate fall risk. leads the meeting. Rehab Department team weekly Rehab Department X X X Department review of rehab patients or staff Internal residents in need of rehab. Review Report data help identify Rehab director residents with factors such typically leads the as ADL decline or balance meeting. changes that indicate an increased risk for falls and the potential need for therapy. Root Cause Multidisciplinary team DON or ADON, nurse X X X X Analysis for review of new falls. Risk manager, QI director, New Falls and trended reports provide rehab therapist or insights into why these director, restorative persons had a new fall. nurse
AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention Implementation Materials Training Handout 3: Meeting Descriptions and Suggested Falls Reports Nursing Home Meetings Meeting Description Typical Attendees and Leads Falls Report Quarterly Summary of Fall Risk Factors by Unit or Facility Monthly Factors by Unit or Facility Postfall Summary Care Plan Meetings Weekly review of resident care plans. Reports help care plan change decisions. Multidisciplinary team DON or ADON typically leads the meeting. X X CNA Shift Change Report CNAs meet at shift change to share summary of residents’ clinical status and residents’ care plan interventions for CNA followup. The charge nurse typically generates the reports for the CNA staff at the beginning of the shift to identify residents with changes in risk. Charge nurse/nurse manager and CNAs Charge nurse or nurse manager typically leads the meeting. X Nurse Shift Change Report Nurses meet at change of shift to review resident clinical and risk status. Risk reports help identify residents at risk for falls that need attention. Nurse managers or charge nurses Nurse managers or charge nurses typically lead the meeting. X Quality Improvement Review The QI Committee may use the reports to identify risk factors most commonly associated with falls in order to help identify facilitywide or unit-level performance improvement projects that may be needed to mitigate fall risk. QI Committee, department heads, including administrator and medical director (or physician/ANP designee) Nursing or QI director leads the meeting. X X Rehab Department Internal Review Department team weekly review of rehab patients or residents in need of rehab. Report data help identify residents with factors such as ADL decline or balance changes that indicate an increased risk for falls and the potential need for therapy. Rehab Department staff Rehab director typically leads the meeting. X X X Root Cause Analysis for New Falls Multidisciplinary team review of new falls. Risk and trended reports provide insights into why these persons had a new fall. DON or ADON, nurse manager, QI director, rehab therapist or director, restorative nurse X X X X
fallspximpl-handouts.docx