Ensuring Evidence-based Practices for Falls Prevention in a Nursing Home Setting

Objective: To evaluate the effectiveness of an ad hoc multifaceted program to improve structure, professional behavior, and outcomes related to falls prevention.

Design: Internal quality improvement cycle.

Setting: Nursing home in Spain.

Participants: An institution with 130 residents.

Intervention: Local building of quality criteria, audit and feedback, and a specific intervention to improve based on educational and sensitization activities and changes in the process and recording systems.

Measurement: Quality of falls prevention was assessed using reliable evidence-based criteria (4 of structure and 9 of process), at baseline and 6 months after a specific intervention to improve. Number of falls was recorded in a random sample (n = 60) of residents (≥ 65 years) during a 1-year follow-up and summarized fortnightly as an indicator analyzed using a statistical control chart.

Results: Baseline structure and fall prevention practices were poor. After the intervention, all structure criteria were present and 8 of 9 process criteria improved significantly. Thirty-two falls occurred 6 months before and 21 after the intervention started, showing a significant decrease in the fortnightly incidence (P < .01).

Conclusions: Adherence to evidence-based recommendations was poor in our setting, but the internal quality improvement cycle was useful in ensuring safe practices and in achieving better outcomes.