MDS Alert

Create a system where falls don't fall through the cracks.

To identify systemic problems causing avoidable falls in your facility, you have to take your facility's risk management program to new heights. These two simple strategies will help you develop and respond to the big picture.

1. Use a consistent fall definition across the board. The MDS fall definition (see the box below to the right) drives the fall quality indicator/measure. Thus, consultant Nancy Augustine, RN, MSN, thinks it's a good idea to use the MDS definition for all risk management efforts. If you want to segregate falls into different categories after the MDS team captures falls using the MDS definition, that's OK, she says. For example, you might classify falls based on whether the resident's fall was intercepted or instances where staff found the resident on the floor. But "surveyors will look at whether the facility is capturing and coding falls based on the MDS definition," reminds Augustine.

2. Recognize the limits of your fall and fall-related injury QIs/QMs. The QIs/QMs showing falls and fractures only trigger on target assessments, observes Augustine, with LTCQ Inc. in Lexington, MA. And, of course, the QI/QM looking at hip and other fractures doesn't include other fall-related injuries. And some fractures captured on the MDS may not be associated with falls. 

Solution: Keep track of all falls and fall-related injuries of any type. Your software may allow you to enter data about falls and other incidents to analyze them, Augustine says. "Or you can do that step manually," she adds.

To obtain the data you need to do root-cause analysis, track residents who have multiple falls, fall frequency, whether an injury occurred, and the time, location and date of falls, Augustine advises. Connect your trending analysis to care processes, suggested Alva "Buzz" Baker, MD, in a presentation on falls at the most recent American Association of Homes & Services for the Aging annual meeting in San Francisco.

Statistical gem: When trending falls, calculate the rate of falls rather than simply the number--unless the facility has an absolutely stable census, Baker advised. Converting the fall numbers to rates allows you to compare apples to apples over time, he noted.