AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention
Electronic Reports
Table 5. Sample Quarterly Summary of Falls Risk Factors by Facility
On-Time Facility-Level Quarterly Summary of Falls Risk Factors
Date: ___/___/___
High-Risk Existing Conditions | |||||||
---|---|---|---|---|---|---|---|
Mental: Unsafe Behaviors |
Mental: Cognitive Impairment |
Gait and Balance Instability |
Fall: 8-30 Days |
Fall: 31-180 Days |
Psychoactive Medications |
Other High-Risk Medications |
|
Unit A | |||||||
# falls | 17 | 21 | 21 | 10 | 11 | 18 | 14 |
% (of Q total falls) | 41 | 51 | 51 | 24 | 27 | 44 | 34 |
Unit B | |||||||
# falls | 9 | 9 | 6 | 3 | 12 | 12 | 5 |
% (of Q total falls) | 24 | 24 | 16 | 8 | 32 | 32 | 14 |
Unit C | |||||||
# falls | 5 | 7 | 7 | 2 | 0 | 6 | 6 |
% (of Q total falls) | 19 | 26 | 26 | 7 | 0 | 22 | 22 |
# falls | 31 | 37 | 34 | 15 | 23 | 36 | 25 |
% (of Q total falls) | 30 | 35 | 32 | 14 | 22 | 34 | 24 |
Table 5. Sample Quarterly Summary of Falls Risk Factors by Facility (continued)
High-Risk Change in Condition | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Acute Mental Status Change |
Behavior: New Unsafe |
New Gait/Balance or Device Order |
New Fall | Med: New Med or Dose Change |
Orthostatic Hypotension/ Dehydration |
Vertigo/ Dizziness |
Syncope/ Fainting |
Hypogly- cemia |
Possible Infection |
New Seizure Activity |
New Admission |
|
Unit A | ||||||||||||
# falls | 3 | 0 | 0 | 15 | 4 | 17 | 4 | 6 | 0 | 4 | 0 | 5 |
% (of Q total falls) | 7 | 0 | 0 | 37 | 10 | 41 | 10 | 15 | 0 | 10 | 0 | 12 |
Unit B | ||||||||||||
# falls | 1 | 4 | 6 | 20 | 2 | 11 | 0 | 2 | 9 | 2 | 1 | 1 |
% (of Q total falls) | 3 | 11 | 16 | 54 | 5 | 30 | 0 | 5 | 24 | 5 | 3 | 3 |
Unit C | ||||||||||||
# falls | 1 | 0 | 0 | 14 | 0 | 14 | 2 | 2 | 9 | 1 | 0 | 1 |
% (of Q total falls) | 4 | 0 | 0 | 52 | 0 | 52 | 7 | 7 | 33 | 4 | 0 | 4 |
# falls | 5 | 4 | 6 | 49 | 6 | 42 | 6 | 10 | 18 | 7 | 1 | 7 |
% (of Q total falls) | 5 | 4 | 6 | 47 | 6 | 40 | 6 | 10 | 17 | 7 | 1 | 7 |
Table 5. Sample Quarterly Summary of Falls Risk Factors by Facility (continued)
New Contributing Risk Factor | Additional Info Within 30 Days | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pain: New or Uncontrolled chronic |
Urinary Incontinence: New or Increase |
Mobility: More Independent | Room Change | Bed Mobility | Transfer | Toileting | Depression Score | Monthly BMI <18.5 kg/m2 |
Significant Wt Change | Vitamin D Order | Osteoporosis | Diabetes | Visual Impairment | |
Unit A | ||||||||||||||
# falls | 3 | 7 | 4 | 12 | 0 | 3 | 0 | 7 | 10 | 1 | 4 | 3 | 18 | 16 |
% (of Q total falls) | 7 | 17 | 10 | 29 | 0 | 7 | 0 | 17 | 24 | 2 | 10 | 7 | 44 | 39 |
Unit B | ||||||||||||||
# falls | 1 | 3 | 0 | 3 | 0 | 7 | 7 | 3 | 3 | 1 | 3 | 1 | 13 | 4 |
% (of Q total falls) | 3 | 8 | 0 | 8 | 0 | 19 | 19 | 8 | 8 | 3 | 8 | 3 | 35 | 11 |
Unit C | ||||||||||||||
# falls | 1 | 1 | 2 | 3 | 0 | 2 | 4 | 2 | 0 | 0 | 11 | 1 | 6 | 4 |
% (of Q total falls) | 4 | 4 | 7 | 11 | 0 | 7 | 15 | 7 | 0 | 0 | 41 | 4 | 22 | 15 |
# falls | 5 | 11 | 6 | 18 | 0 | 12 | 11 | 12 | 13 | 2 | 18 | 5 | 37 | 24 |
% (of Q total falls) | 5 | 10 | 6 | 17 | 0 | 11 | 10 | 11 | 12 | 2 | 17 | 5 | 35 | 23 |
Table 5. Sample Quarterly Summary of Falls Risk Factors by Facility (continued)
Injury | Totals | ||||
---|---|---|---|---|---|
Fall With Major Injury |
Fall With Minor Injury |
Total Residents Who Fell |
Total Residents With >1 Fall |
Total Falls |
|
Unit A | |||||
# falls | 6 | 35 | 30 | 7 | 41 |
% (of Q total falls) | 15 | 85 | |||
Unit B | |||||
# falls | 2 | 35 | 31 | 4 | 37 |
% (of Q total falls) | 5 | 95 | |||
Unit C | |||||
# falls | 1 | 26 | 22 | 3 | 27 |
% (of Q total falls) | 4 | 96 | |||
# falls | 9 | 96 | 83 | 14 | 105 |
% (of Q total falls) | 9 | 91 |