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Implementing a Fall Prevention Program Implementing a best practice fall prevention program has proven to be successful in reducing falls in elderly long-term care patients. It is common knowledge that fall prevention is crucial for this population. Best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation (National Guideline Clearinghouse, 2009). Timeline A fall prevention program should initially be piloted on one unit where it is likely to succeed before introducing it to the entire facility. A pilot study can reveal deficiencies in the project that can be addressed before time and resources are expended on a larger scale. Piloting on a unit will also allow closer monitoring of the results for evaluation before finalizing plans for program implementation. Clinical Practice Guidelines Clinical practice guideline recommendations important to the successful implementation of a fall prevention program are included in the best practices guideline published in the National Guideline Clearinghouse (2009). The guidelines are as follows: Assessment: The clinical guidelines recommend assessing fall risks on admission and after a fall. Knowing who is at risks for falls is important in deciding who needs to be in the fall prevention program. Assessing after a fall is important when looking at root cause and interventions to preventing future falls. This is also important in determining if the current fall prevention intervention is effective. Exercise: While this is not recommended as a stand alone intervention, the clinical guidelines recommend that nurses use strength training exercise as a component of a fall intervention program. Multi-factorial: It is important when developing a fall prevention program to look at the predisposing and precipitating factors that affect a patient’s or resident’s fall risk. Implementing a variety of fall prevention interventions based upon known risk factors for falls the elderly can help in reducing future falls. Medications: The clinical guideline recommends that nurses consult with the health care team and conduct periodic medication reviews to prevent falls among elderly in long term care settings. Clients taking benzodiazepine, tricyclic antidepressant, selective serotonin-uptake inhibitors, trazadone, or more than five medications should be identified as high risk for falls. Medication review should be conducted periodically throughout the institutional stay. Most elderly long-term care residents are on multiple medications, sometimes referred to as “polypharmacy”, which places them at increased risk for falls. Client Education: The clinical guidelines recommend educating patients that have been determined to be at increased risk for falls. Educating the patient on falls and fall prevention interventions increases safety awareness and reduces the fear of falling. When developing educational materials for this population, the nurse educator should consider factors affecting the aging process, and utilize methods consistent with adult learning principles. Environment: The clinical guideline recommends that nurses should include environmental modification as a component of fall prevention strategies. Examining the environment for wet areas, clutter, poor lighting, and other environmental factors can reduce the risk of falling in nursing home patients. Strategies that can be used to facilitate incorporating the recommendations into clinical practice based upon guidelines of the National Guidelines Clearinghouse, 2009: 1. Establish a fall committee. The members should be committed to leading the initiative. Assign someone to document and track activities and timelines. 2. Assign a dedicated clinical resource nurse who will provide support, clinical expertise, mentorship, and leadership. The individual should also have good interpersonal, facilitation, and project management skills.
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