Fall risk care processes in nursing home facilities.

摘要

OBJECTIVE: To explore the relationships between fall risk factors and care plan intervention and implementation. DESIGN: Observational cohort study. SETTING: Nursing homes in Central Ontario, Canada. PARTICIPANTS: Residents (n = 635) of 8 nursing homes across Ontario, Canada. MEASUREMENTS: Chart reviews and observational rounds on nursing units were carried out to examine how well nursing staff (1) identified fall risk, (2) documented nursing care plan interventions, and (3) implemented nursing care plan interventions in residents who had fallen in the preceding year. RESULTS: Of the 635 fallers, two thirds (65.9%) had a history of falls. A total of 94 fallers across the 8 facilities had no fall risk care plan included in their medical record, despite having fallen previously. Only 63.46% of nursing care plan interventions were successfully implemented. Shorter length of stay (P < .001; odds ratio [OR] 0.09; 95% confidence interval [CI] 0.04-0.23), fall history (P = .002; OR 2.14; 95% CI 1.32-3.46), and those who are widowed (P = .001; OR 2.53; 95% CI 1.43-4.48) and divorced (P = .03; OR 2.16; 95% CI 1.06-4.40) predicted a higher likelihood of falls. CONCLUSION: This study revealed significant breakdowns in care related to the lack of documented care plan interventions for residents with a history of falls, and lack of implementation in cases where care plan interventions were made. Policies and procedures to improve the selection and implementation of care plan interventions may result in substantial improvements in nursing home safety.