Fall prevention among veterans in a skilled nursing facility

ABSTRACT

Background: In skilled nursing facilities (SNF), 50-70% of residents fall per year. SNF residents with dementia are more prone to fall, with an annual incidence of 60%. The Community Living Center (CLC) at the San Francisco Veterans Affairs Medical Center (SFVAMC), reported annual fall rate of 50%, compared to the national VA fall rate of 42%. Our goal was to reduce the rate of fall by 20% compared to fiscal year 2019. Methods: We conducted process mapping with CLC interdisciplinary team members to identify barriers to fall prevention. The barriers included staff, patient population-specific challenges, environmental obstacles, and documentation, communication, and care protocol. Studies have shown that multi-pronged approaches yield the best results. We implemented 3 interventions: fall education, purposeful huddles, and toilet seat risers. Physical therapists and occupational therapists stated that low toilet seats were fall risk for Veterans. Results: We partnered with the CLC's nurse educator to adapt the “5 P's Proactive Patient Rounding” education tool as a pocket card for the CLC nursing staff. By end of May 2020, all CLC nurses were educated in these 5 P's and fall prevention. Watch List Huddle was started in January 2020, to discussed care plans for residents who nurses were concerned about. Every resident who fell were discussed during these rounds which met three times a week. Lastly, toilet seat risers were placed in each bathroom in July 2020. Implementation of our interventions lead to 40% decrease in the average number of falls. Conclusion: Re-training in fall prevention, improving communication and care plan after fall and raising the toilet seats significantly reduce the rate of falls by 40%. This result was much larger than our goal 20% reduction. An increase in nursing staff hiring and a decreased census within the CLC due to COVID-19 quarantine may have contributed to better than expected outcome.