JAMDA
Volume 8, Issue 3, Supplement , Pages S26-S36 , March 2007

A Model Quality Improvement Program for the Management of Falls in Nursing Homes

  • Jo A. Taylor, RN, MPH

      Affiliations

    • The Emory Center for Health in Aging, Atlanta, GA
    • Corresponding Author InformationAddress correspondence to Jo A. Taylor, RN, MPH, Emory Center for Health in Aging 1841 Clifton Road, NE, Atlanta, GA 30329.
    • ,
  • Patricia Parmelee, PhD

      Affiliations

    • The Department of Psychiatry and Behavioral Science, Emory School of Medicine, Atlanta, GA
    • The Atlanta Veterans Affairs Medical Center and Birmingham/Atlanta VAMC Geriatric Research, Education & Clinical Center, Atlanta, GA.
    • ,
  • Holly Brown, MSN, APRN-BC

      Affiliations

    • The Emory Center for Health in Aging, Atlanta, GA
    • The Emory Nell Hodgson Woodruff School of Nursing, Atlanta, GA
    • ,
  • Harry S. Strothers III, MD, MMM

      Affiliations

    • The Morehouse University School of Medicine, Atlanta, GA
    • ,
  • Elizabeth Capezuti, PhD, RN, FAAN

      Affiliations

    • The John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing, New York, NY
    • ,
  • Joseph G. Ouslander, MD

      Affiliations

    • The Emory Center for Health in Aging, Atlanta, GA
    • The Emory Nell Hodgson Woodruff School of Nursing, Atlanta, GA
    • The Division of Geriatric Medicine and Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, GA
    • The Atlanta Veterans Affairs Medical Center and Birmingham/Atlanta VAMC Geriatric Research, Education & Clinical Center, Atlanta, GA.

References 

  1. Ray WA, Taylor JA, Meador KG, et al. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA. 1997;278:557–562
  2. Becker C, Kron M, Lindemann U, et al. Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc. 2003;51:306–313
  3. Jensen J, Lundin-Olsson L, Nyberg L, et al. Fall and injury prevention in older people living in residential care facilities: A cluster randomized trial. Ann Intern Med. 2002;136:733–741
  4. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;(4):CD000340
  5. American Geriatrics SocietyBritish Geriatrics SocietyAmerican Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49:664–672
  6. American Geriatrics SocietyBritish Geriatrics SocietyAmerican Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guidelines for the prevention of falls in older persons. Ann of Long-Term Care. 2001;9:42–57
  7. American Medical Directors Association. Falls and Fall Risk: Clinical Practice Guidelines. Columbia, MD: American Medical Directors Association; 2003;
  8. Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomized clinical trials. BMJ. 2004;328:680–687
  9. Taylor JA. The Vanderbilt fall prevention program for long-term care: Eight years of field experience with nursing home staff. J Am Med Dir Assoc. 2002;3:180–185
  10. Capezuti E, Taylor JA, Brown H, et al. Challenges to implementing an APN-facilitated falls management program in long-term care. Appl Nurs Res. In press.
  11. Parmelee PA. Quality improvement in nursing homes: The elephants in the room. J Am Geriatr Soc. 2004;52:2138–2140
  12. Ray WA, Taylor JA, Brown AK, et al. Prevention of fall-related injuries in long-term care: A randomized controlled trial of staff education. Arch Intern Med. 2005;165:2293–2298
  13. Colon-Emeric C, Schenck A, Gorospe J, et al. Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative. J Am Geriatr Soc. 2006;54:1414–1418
  14. Harrington C. Nurse staffing in nursing homes in the United States: Part II. J Gerontol Nurs. 2005;31:9–15
  15. Castle NG. Administrator turnover and quality of care in nursing homes. Gerontologist. 2001;41:757–767
  16. Institute for the Future of Aging Services. Act Now for Your Tomorrow, Final Report of the National Commission on Nursing Workforce for Long-Term Care. April, 2005. Available at: http://www.futureofaging.org/page.cfm?name=SA_Workforce_Publications&pubid=88&ID=1. Accessed September, 2006.
  17. Gifford D, Patry G, Kissam S. An overview of the challenges to quality improvement in nursing homes. Providence, RI: Rhode Island Quality Partners; 2002;
  18. Rader J, Jones D, Miller L. The importance of individualized wheelchair seating for frail older adults. J Gerontol Nurs. 2000;26:24–32
  19. Jones D. Real solutions. Team Rehab Rep. 1995;Sept:14–16
  20. Kapp MB. Resident safety and medical errors in nursing homes: Reporting and disclosure in a culture of mutual distrust. J Legal Med. 2003;24:51–76
  21. Advancing Excellence in America’s Nursing Homes. Campaign Goals. 2006;Available at: http://www.nhqualitycampaign.org. Accessed November, 2006.
  22. Rask K, Parmelee PA, Taylor JA, et al. Implementation and evaluation of a nursing home falls management program. J Amer Geriat Soc. In press.
  23. Carman JM, Shortell SM, Foster RW, et al. Keys for successful implementation of continuous quality improvement in hospitals. Health Care Management Res. 1996;21:48–60
  24. Narine L, Persaud DD. Gaining and maintaining commitment to large-scale change in healthcare organizations. Health Serv Manage Res. 2003;16:179–187
  25. Vincent CA, Taylor-Adams S, Stanhope N. Framework for analyzing risk and safety in clinical medicine. BMJ. 1998;316:1154–1157
  26. National Quality Forum. Safe Practices for Better Health Care: A Consensus Report. 2003;Summary. Agency for healthcare research and quality, Rockville, MD; Available at: http:xxwww.ahrq.govxqualxnqfpract.htm. Accessed September, 2006.
  27. Cohen MM, Eustis MA, Gribbins RE. Changing the culture of patient safety: Leadership’s role in health care quality improvement. Jt Comm J Qual Saf. 2003;29:329–335
  28. Rantz MJ, Hicks L, Grando V, et al. Nursing home quality, cost, staffing, and staff mix. Gerontologist. 2004;44:24–38
  29. Brashier LW, Sower VE, Motwani J, Savoie M. Implementation of TQM/CQI in the health-care industry: A comprehensive model. Benchmarking: An International Journal. 1996;3:31–50
  30. Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press; 2001;
  31. Ryden MB, Snyder M, Gross C, et al. Value-added outcomes: the use of advanced practice nurses in long-term care facilities. Gerontologist. 2000;40:654–662
  32. Shortell SM, O’Brien JM, Carman R, et al. Physician involvement in quality improvement: Issues, challenges, and recommendations. In: Blumenthal D, Scheck AC, eds. Improving Clinical Practice: Total Quality Management and the Physician. San Francisco, CA: Jossey-Bass, pp. 205–228.
  33. Krichbaum K, Pearson V, Savik K, et al. Improving resident outcomes with GAPN organization level interventions. West J Nurs Res. 2005;27:322–337
  34. Rantz MJ, Popejoy L, Petroski GF, et al. Randomized clinical trial of a quality improvement intervention in nursing homes. Gerontologist. 2001;41:525–538
  35. Wagner LM, Capezuti E, Taylor JA, et al. Impact of a falls menu-driven incident-reporting system on documentation and quality improvement in nursing homes. Gerontologist. 2005;45:835–842

 Funded in part by a grant from the Agency for Healthcare Research and Quality (#290-00-0011), and by support from the Birmingham/Atlanta VA GRECC.The Falls Management Program materials are available on http://www.medqic.org, an online resource for quality improvement sponsored by the Centers for Medicaid and Medicare Services.

PII: S1525-8610(06)00586-X

doi: 10.1016/j.jamda.2006.11.005

JAMDA
Volume 8, Issue 3, Supplement , Pages S26-S36 , March 2007

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