Ensuring evidence-based practices for falls prevention in a nursing home setting.

摘要

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.