MinimisingMinimising thethe RiskRisk ofof FallsFalls & Fall-relatedFall-related InjuriesInjuries Guidelines for Acute, Sub-acute and Residential Care Settings Tools Supplement Published by the Metropolitan Health and Aged Care Services Division Disclaimer Victorian Government Department of Human Services This document should not be considered prescriptive. Health Melbourne Victoria care staff should work with patient/residents and their July 2004 families/carers to ensure that the most appropriate care and © Copyright State of Victoria, Department of Human Services, 2004 treatment is provided to the individual. Some flexibility will be required to adapt these Guidelines to specific settings, local This publication is copyright. No part may be reproduced by any process except in accordance with the circumstances and to individual patient/resident needs. provisions of the Copyright Act 1968. Every effort has been made to ensure that the information provided in this document is accurate and complete at the time Design by Watts Design. 3290 of development. However the Victorian Quality Council, the authors, or any person that has contributed to its development do not accept liability or responsibility for any errors or omissions that may be found, or any loss or damage incurred as a result of relying on the information in this document. Victorian Quality Council Secretariat Phone 1300 135 427 Email [email protected] website http://qualitycouncil.health.vic.gov.au VQC: MINIMISING THE RISK OF FALLS AND FALL-RELATED INJURIES: GUIDELINES FOR ACUTE, SUB-ACUTE AND RESIDENTIAL CARE SETTINGS: TOOLS SUPPLEMENT 1. INTRODUCTION 1 4. FALLS INCIDENT REPORT 30 How this Tools Supplement may be used 1 Falls Report – Goulburn Valley Health T.18 Types of sample tools included 1 How the sample tools were selected 1 5. POST-FALL PATHWAY 34 About the selected tools 2 Post Fall Team Management Protocol (The Alfred) T.19 Tips for selecting tools 2 Falls Pathway for a Patient who has Fallen (Western Health) T.20 2. FALLS RISK SCREENING (STEP 1) 6. PATIENT/RESIDENT INFORMATION RESOURCES 38 AND FALLS RISK ASSESSMENT (STEP 2) TOOLS 3 NARI/MECRS patient/resident brochure: A guide to reducing your risk Summary of Falls Risk Screening Tools (Step 1) & of falling while in hospital and Falls Risk Assessment Tools (Step 2) - Issues to note: 3 Queensland Health patient/resident Brochure: Falls Prevention Admission Risk Screening Tool – Melbourne Health T.01 Falls Risk Assessment Tool - Latrobe Regional Hospital T.02 7. MEDICATIONS ASSOCIATED WITH INCREASED Falls Risk Assessment: Residential Care - Melbourne Health and NARI T.03 FALLS RISK 40 Falls Screen - Latrobe Regional Hospital FARAM (Falls Assessment, Risk and Management) - Bayside Health T.05 8. VICTORIAN CORONER’S STANDARD FOR FRASS (Falls Risk Assessment Scoring System) - Bayside Health T.06 INVESTIGATION (OF FALL-RELATED DEATHS) 42 FRAT (Falls Risk Assessment Tool) – Peninsula Health T.07 Contents FRHOP (Falls Risk for Hospitalised Older People) 9. COGNITIVE IMPAIRMENT TESTS 46 – Melbourne Health and NARI T.08 Abbreviated Mental Test Score (AMTS) T21 PJC FRAT (Peter James Centre Falls Risk Assessment Tool) T.09 Mini-Mental State Examination (MMSE) T22 STRATIFY T.10 STRATIFY (modified Bendigo version) T.11 10.FALLS AND FALL-RELATED INJURY RISK The Northern Hospital modified STRATIFY T.12 MINIMISATION AUDIT 50 WHeFRA (Western Health Falls Risk Assessment) T.13 11.FALLS INCIDENT DATA MANAGEMENT 3. ENVIRONMENTAL AUDITS 26 FRAMEWORK (EXCEL FILE) 52 Peninsula Health Individual Environmental Checklist T.14 Queensland Health Individual Environmental Checklist T.15 Peninsula Health General Environmental Checklist T.16 Queensland Health General Environmental Checklist T.17 iv 01 Introduction How this Tools Supplement may a falls incident report Services and the Victorian Quality Council, and be used centres known to be involved in falls prevention post-fall pathways This Supplement contains a selection of falls project activity by the project team. patient/resident information resources and fall-related injury risk minimisation tools and The survey included questions about tools and resources for use in hospital and residential list of medications associated with resources in use in different areas of falls care settings. It should be used in conjunction increased falls risk minimisation activity, for example: with the Victorian Quality Councils “Minimising Falls and Fall-related injuries: Guidelines for Victorian Coroner’s Standard for falls risk screening tools Investigation (of falls related deaths) Acute, Sub-acute and Residential Care falls risk assessment tools settings” document and associated resources. Introduction cognitive impairment tests information brochures for patient/residents falls and fall-related injury risk minimisation and carers Types of sample tools included program audit, and The term ‘Tools’ refers to a range of support training programs, and falls incident data management framework documentation and resources that may be environmental audits. useful in the implementation of a program to (Excel file). The survey asked respondents: minimise the risk of falls and fall-related injuries Where possible, a range of sample tools have in hospitals or residential care settings. been selected for each type, to provide options to list the tool(s) they were using for use in different settings. The types of tools included are as follows: to identify whether it was an established falls risk screening tools tool(s) they had adopted, or was modified How the sample tools were selected or self-developed, and falls risk assessment tools A survey was distributed to Victorian hospitals whether they would recommend use of the 01 and residential care facilities, identified from lists environmental audits (both individual and tool(s) to other centres. general environment) generated by the Department of Human VQC: MINIMISING THE RISK OF FALLS AND FALL-RELATED INJURIES: GUIDELINES FOR ACUTE, SUB-ACUTE AND RESIDENTIAL CARE SETTINGS: TOOLS SUPPLEMENT A range of tools were contributed to the project and, based on the information provided, these tools were Tips for selecting tools reviewed by an Expert Panel for inclusion as samples in these Guidelines. The criteria used to conduct this review of the Tools are summarised as follows: Review examples of other tools used in a Criteria Description similar setting Face validity Does the tool appear to meet the intended purpose? Discuss the options with staff involved, Content/construct Any validation undertaken to support the utility/effectiveness of the tool taking into account their preferences about validity The factual accuracy (content validity) of the tool practical application The research evidence supporting the use of the type of tool Consider any research that has been done Utility The presentation style of the tool that supports the effectiveness of the The number of users/centres for a particular tool based on survey responses tool(s), particularly in a similar setting The number of users/centres for a particular tool based on survey responses Contact the developers of the tool(s) and that indicated they would recommend others to use the tool discuss any problems they have identified Other criteria Other features of the tool that might influence its rating with the use of their tool(s) Consider the usefulness of the tool(s) in While none of the tools reviewed met all of the criteria, recommended Tools have been selected based on supporting the implementation of strategies meeting the majority of the defined criteria. At the beginning of each section there is a table summarising the for falls and fall-related injury risk strengths and limitations of the tools. These tables may assist health care facilities to decide on the most minimisation in your setting. appropriate tool(s) for their setting. About the selected tools The tools provided are not intended to be representative of all available tools, nor are the samples intended to exemplify the ideal tools. They are intended to provide a starting point for organisations that wish to implement a program for minimising the risk of falls and fall-related injury or revise their current one. Given the substantial level of falls prevention activity currently happening in hospitals and residential care, it is envisaged that there will be a need to consider newly developed resources against similar criteria to determine their potential usefulness compared to those included in this document. The organisations involved in the development of the tools in this Supplement have given permission for the: inclusion of the tool in these Guidelines, and use of the tool by other organisations or centres, providing the source of the tool is acknowledged (information about the required acknowledgement is included on the introductory page for each tool). 02 02 Falls Risk Screening (Step 1) and Falls Risk Assessment (Step 2) Tools Refer to the Process Model in the Minimising Falls and Fall-related Injuries Guidelines and the supporting information for Steps 1 and 2 of the Process Model. Falls risk screening refers to a brief (often less than 5 item) check to identify patient/residents at risk of falling and who need to have a more detailed assessment of falls risk carried out. By contrast, falls risk assessment is a systematic, comprehensive process to identify an individual patient/resident’s risk factors for falling. Once identified, risk factors are used to develop Issues to note: the patient/resident’s falls and fall-related