AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention
Electronic Reports
Monthly Contextual Factors Report
Table 7. Sample Monthly Contextual Factors Report by Facility
Monthly Contextual Factors Report
Date: ___/___/___
Day of Week | Shift | Time of Day | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | Days | Evenings | Nights | 7 a.m. - 9:59 a.m. | 10 a.m. - 11:59 a.m. | 12p.m. to 1:29 p.m. | 1:30 p.m. to 2:59 p.m. | 3p.m. - 4:59 p.m. | 5p.m. - 7:59 p.m. | 8p.m.-10:59 p.m. | 11p.m.- 12:59p.m. | 1 a.m.- 4:59 a.m. | 5 a.m. - 6:59 a.m. | |
Unit A | ||||||||||||||||||||
# falls | 0 | 0 | 2 | 0 | 0 | 1 | 1 | 1 | 2 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 |
% (of total falls) | 0 | 0 | 50 | 0 | 0 | 25 | 25 | 25 | 50 | 25 | 0 | 0 | 0 | 25 | 25 | 25 | 0 | 0 | 25 | 0 |
Unit B | ||||||||||||||||||||
# falls | 1 | 2 | 1 | 1 | 2 | 1 | 0 | 2 | 3 | 3 | 2 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
% (of total falls) | 13 | 25 | 13 | 13 | 25 | 13 | 0 | 25 | 38 | 38 | 25 | 0 | 0 | 0 | 13 | 13 | 13 | 13 | 13 | 13 |
Unit C | ||||||||||||||||||||
# falls | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 2 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
% (of total falls) | 0 | 0 | 33 | 33 | 33 | 0 | 0 | 33 | 67 | 0 | 0 | 0 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Facility Totals | ||||||||||||||||||||
# falls | 1 | 2 | 4 | 2 | 3 | 2 | 1 | 4 | 5 | 5 | 2 | 0 | 3 | 1 | 2 | 2 | 1 | 1 | 2 | 0 |
% (of total falls) | 7 | 13 | 27 | 13 | 20 | 13 | 7 | 27 | 33 | 33 | 13 | 13 | 20 | 7 | 13 | 13 | 7 | 7 | 13 | 0 |
Table 7 (continued)
Day of Week | Shift | Location | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | Days | Evenings | Nights | In room | Bathroom | Hallway | Dining Room | Activities | Therapy | Beauty/Barber | Shower/Tub | Nursing Station | Out of Facility | Other | |
Unit A | |||||||||||||||||||||
# falls | 0 | 0 | 2 | 0 | 0 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 |
% (of total falls) | 0 | 0 | 50 | 0 | 0 | 25 | 25 | 25 | 50 | 25 | 25 | 25 | 0 | 0 | 0 | 0 | 0 | 50 | 0 | 0 | 0 |
Unit B | |||||||||||||||||||||
# falls | 1 | 2 | 1 | 1 | 2 | 1 | 0 | 2 | 3 | 3 | 3 | 2 | 1 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 |
% (of total falls) | 13 | 25 | 13 | 13 | 25 | 13 | 0 | 25 | 38 | 38 | 38 | 25 | 13 | 0 | 0 | 0 | 0 | 25 | 0 | 0 | 0 |
Unit C | |||||||||||||||||||||
# falls | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 2 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
% (of total falls) | 0 | 0 | 33 | 33 | 33 | 0 | 0 | 33 | 67 | 0 | 0 | 0 | 0 | 33 | 33 | 33 | 0 | 0 | 0 | 0 | 0 |
Facility Totals | |||||||||||||||||||||
# falls | 1 | 2 | 4 | 2 | 3 | 2 | 1 | 4 | 5 | 5 | 4 | 3 | 1 | 1 | 1 | 1 | 0 | 4 | 0 | 0 | 0 |
% (of total falls) | 7 | 13 | 27 | 13 | 20 | 13 | 7 | 27 | 33 | 33 | 27 | 20 | 7 | 7 | 7 | 7 | 0 | 27 | 0 | 0 | 0 |
Table 7 (continued)
Day of Week | Shift | Other | Fall totals | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | Days | Evenings | Nights | Room Change Within 30 Days of Fall Date | Total Residents Who Fell | Total Residents With >1 Fall | Total Falls | |
Unit A | ||||||||||||||
# falls | 0 | 0 | 2 | 0 | 0 | 1 | 1 | 1 | 2 | 1 | 3 | 3 | 1 | 4 |
% (of total falls) | 0 | 0 | 50 | 0 | 0 | 25 | 25 | 25 | 50 | 25 | 75 | |||
Unit B | ||||||||||||||
# falls | 1 | 2 | 1 | 1 | 2 | 1 | 0 | 2 | 3 | 3 | 5 | 6 | 2 | 8 |
% (of total falls) | 13 | 25 | 13 | 13 | 25 | 13 | 0 | 25 | 38 | 38 | 63 | |||
Unit C | ||||||||||||||
# falls | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 2 | 0 | 0 | 3 | 0 | 3 |
% (of total falls) | 0 | 0 | 33 | 33 | 33 | 0 | 0 | 33 | 67 | 0 | 0 | |||
Facility Totals | ||||||||||||||
# falls | 1 | 2 | 4 | 2 | 3 | 2 | 1 | 4 | 5 | 5 | 8 | 12 | 3 | 15 |
% (of total falls) | 7 | 13 | 27 | 13 | 20 | 13 | 7 | 27 | 33 | 33 | 53 |
Note: Percentages may not add to 100 due to rounding.