Translating Evidence‐Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative

Abstract

OBJECTIVES: To describe the changes in process of care before and after an evidence‐based fall reduction quality improvement collaborative in nursing facilities. DESIGN: Natural experiment with nonparticipating facilities serving as controls. SETTING: Community nursing homes. PARTICIPANTS: Thirty‐six participating and 353 nonparticipating nursing facilities in North Carolina. INTERVENTION: Two in‐person learning sessions, monthly teleconferences, and an e‐mail discussion list over 9 months. The change package emphasized screening, labeling, and risk‐factor reduction. MEASUREMENTS: Compliance was measured using facility self‐report and chart abstraction (n=832) before and after the intervention. Fall rates as measured using the Minimum Data Set (MDS) were compared with those of nonparticipating facilities as an exploratory outcome. RESULTS: Self‐reported compliance with screening, labeling, and risk‐factor reduction approached 100%. Chart abstraction revealed only modest improvements in screening (51% to 68%, P<.05), risk‐factor reduction (4% to 7%, P=.30), and medication assessment (2% to 6%, P=.34). There was a significant increase in vitamin D prescriptions (40% to 48%, P=.03) and decrease in sedative‐hypnotics (19% to 12%, P=.04) but no change in benzodiazepine, neuroleptic, or calcium use. No significant changes in proportions of fallers or fall rates were observed according to chart abstraction (28.6% to 37.5%, P=.17), MDS (18.2% to 15.4%, P=.56), or self‐report (6.1–5.6 falls/1,000 bed days, P=.31). CONCLUSON: Multiple‐risk‐factor reduction tasks are infrequently implemented, whereas screening tasks appear more easily modifiable in a real‐world setting. Substantial differences between self‐reported practice and medical record documentation require that additional data sources be used to assess the change‐in‐care processes resulting from quality improvement programs. Interventions to improve interdisciplinary collaboration need to be developed.