Tools and Critical Interventions: Falls Risk Assessment And Prevention
Goal: standardized fall risk assessment on every home health and hospice patient, with a falls prevention plan implemented for patients at high risk.
- A falls risk assessment is completed as part of the initial assessment by team members of the IDT.
- Build assessment tools into electronic records
- Use prompts to ensure any findings are acted on
- Develop protocols for referring patient to PCP or specialty care if at high falls risk
- There is an agency-specific process is in place for accurate/reliable occurrence reporting, auditing, tracking and trending of falls metrics.
- Interventions are tailored to the identified specific risk factors.
This VNAA Best Practice includes the following critical interventions and actions:
- For falls risk assessment VNAA recommends the Missouri Alliance for Home Care 10 (MAHC-10) tool. The MAHC-10 consists of the required ten core elements, initial instructions, scoring mechanism and threshold for risk, all of which may not be altered or changed in any way. The word “MAHC-10” must remain on the form or be embedded with the tool. Please follow the rules for using the MAHC-10 Tool. Credit must be given to the Missouri Alliance for Home Care.
- Patient-specific falls prevention interventions that address the identified risk factors are part of the physician-ordered plan of care. (AGS/BGS Clinical Practice Guideline, 2013)
- All patients at high risk for falls are offered an exercise program for strength, balance and gait training. Useful tools are found in HHQI (page 10-12), AGS (page 2), Improve your Balance in 10 minutes, TUG, Tinetti, Berg Balance)
| Risk Factors | Preventive Interventions |
| Incontinence | Full RN assessment including type of incontinence, medication implications, teaching opportunities, e.g., Kegel exercises |
| Visual impairment | OT referral for environmental modifications |
| Impaired functional mobility | PT, OT, RN, MSW assessments based on specific dysfunction and need for personal care support |
| Environmental hazards | OT, PT referrals and room-to-room recommendations |
| Poly pharmacy | RN medication management with MD and pharmacy consultation focused on high risk medications, duplicative therapy, and clarification of current prescriptions and timing of doses to help reduce risks |
| Pain affecting level of function | RN for complete pain assessment with non-pharmacological interventions and pharmacological interventions if needed |
| Cognitive impairment | Referral to speech therapy if indicated. These patients often need the assistance of home health aides to help family caregivers. Medical Social Work intervention should be focused on identifying volunteer or paid home health aide services to help prevent falls by providing safe assistance with all ADLs. |
| Pain | Pain is a falls risk factor since it has a negative effect on a patient’s level of function. Non-pharmacological interventions are preferred from a falls risk perspective but pharmacological interventions should be used with caution if necessary. |
The tools linked below were evaluated by the VNAA Best Practices Work Group and are offered for duplication and use. All are used with permission from the authors and/or organizations that originated the material. Please retain all logos and citations where authors/originators are listed on these resources.
For questions or comments about these resources, contact us.