AHRQ Innovations Exchange | Primary Care Nurses Systematically Assess Fall Risk, Provide Real-Time, Easy-to-Use Alerts to Physicians to Facilitate App

Primary Care Nurses Systematically Assess Fall Risk, Provide Real-Time, Easy-to-Use Alerts to Physicians to Facilitate Appropriate Interventions for Those at Risk

Snapshot
Summary
Primary care clinic nurses and home-based primary care nurses at a Veterans Affairs medical center systematically assess the risk of falls in all patients. Using a modified version of an established test for fall risk (the 10 Foot Get Up and Go Test), nurses carefully observe patients as they walk into the clinic to identify any gait or balance issues; they also screen patients for risk of falling, inquiring primarily about any recent falls. Nurses record their observations through an electronic form (known as the Fall Risk Screen-Outpatient Reminder), including any comments they may have in an open text box. Physicians receive immediate alerts through the electronic medical record for those deemed to be at risk; the alert reminds them to assess certain risk factors (e.g., medication use, joint problems, vision changes, gait and balance problems) and to develop an action plan to reduce these risks (e.g., education, balance exercises, assistive devices, in-home review of environmental hazards). Although no formal program evaluation has been conducted, anecdotal feedback from physicians and nurses has been quite positive, and nearly all physicians and nurses routinely use the approach.

Evidence Rating
Suggestive: The evidence consists of anecdotal feedback and perceptions from doctors and nurses using the program; no formal evaluation has been conducted.

Developing Organizations
Jack C. Montgomery VA Medical Center
Muskogee, OK

Date First Implemented
2006
The program was pilot tested in the fall of 2006 and rolled out across the organization in January 2007.
Patient Population
Age > Senior adult (65-79 years); Aged adult (80+ years); Vulnerable Populations > Military/Dependents/Veterans


What They Did
Problem Addressed
Falls are common and a major cause of injury and premature death, particularly among seniors and other at-risk individuals who live in the community. Traditional risk assessment systems were designed for the inpatient setting, making it difficult to use them in primary care and outpatient settings.


A common problem, especially among at-risk community-dwelling individuals: Approximately 30 percent of community-dwelling seniors fall each year,1 while more than one-third of all adults aged 65 years and older are injured in a fall each year.2 Roughly 1 in 12 (8 percent) of those age 70 or older visit the emergency department because of a fall each year, with one-third of these individuals being hospitalized.3

Devastating, costly consequences: Falls are the leading cause of injury-related deaths and the most common cause of nonfatal injuries and hospital admissions for trauma.2 Falls are the fifth leading cause of death among older adults and responsible for two-thirds of all accidental deaths in the U.S.3 The risk of being injured from a fall increases with age, with 72 percent of fall-related deaths occurring in the 13 percent of the population age 65 or older.3 In 2001, an adult aged 85 years and older had a four to five times greater chance of being injured in a fall than did an adult aged 65 to 74 years.4 More than 4 in 10 of those who fall (42 percent) must reduce their activity level as a result, with 18 percent having activities significantly restricted.3 In 2000, the direct medical costs associated with nonfatal fall injuries totaled $19 billion, while the costs of fatal falls totaled $179 million.5

Inadequacy of traditional assessment systems: The Morse Fall Risk Assessment is routinely used in the inpatient setting to assess fall risk. Many outpatient and primary care clinics, including those affiliated with the Jack C. Montgomery Veterans Affairs (VA) Medical Center, have historically used this system as well, even though it is not ideal for the outpatient setting. For example, the Morse approach includes elements not generally relevant to relatively healthy patients (e.g., it inquires about intravenous therapy) and does not allow for any general commentary or notes about potential risk factors that might be relevant to community-dwelling individuals (e.g., secondary conditions such as diabetes or high blood pressure, environmental hazards in the home).

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AHRQ Innovations Exchange | Primary Care Nurses Systematically Assess Fall Risk, Provide Real-Time, Easy-to-Use Alerts to Physicians to Facilitate Appropriate Interventions for Those at Risk