Michael Cary, Amber Anderson, Andrew Burd and Eleanor McConnell recently published an article entitled "Management Team Perceptions of Risk and Strategies for Preventing Falls among Short-stay Patients in Nursing Homes" in Health Care Management. Co-authors include experts from Durham Veterans Affairs Medical Center, Duke University School of Medicine and University of North Carolina at Chapel Hill School of Nursing.

Abstract

Background: We sought to understand strategies reported by members of the nursing home management team are used to prevent falls in short-stay nursing home patients.

Design, Setting, and Subjects: Using Donabedian’s model of structure, process, and outcomes we conducted interviewed six-teen managers from four nursing homes in central North Carolina.

Results: Nursing home managers identified specific barriers to fall prevention among short-stay patients including: rapid changes in functional and cognitive status, staff unfamiliarity with short-stay patient needs and patterns, and policies impacting care. Few interventions for reducing falls among short-stay patients were employed at the structure-level (e.g., specialized units, workload ratio, and staffing consistency); however many process-level interventions were employed (e.g., patient education on problem-solving, self-care/mobility, and safety).

Conclusion: We described several barriers to fall prevention among short-stay patients in nursing homes. From these descriptions, we propose three interventions that might reduce falls for short-stay patients and could be tested in future research: 1) clustering short-stay patients within a physical location to permit higher staff-patient ratios and enhanced surveillance; 2) population-based prevention interventions to supplement existing individually-tailored prevention strategies (e.g., toileting schedules, medication review for all); and 3) transitional care interventions that transmit key information from hospitals to nursing homes.