OASIS-Central

Evidence-based practice is defined per the Disease Management Association of America as using the best scientific evidence available to guide clinical decision-making. Investigating scientific evidence such as best practice research that is available through the National Guideline Clearinghouse Web site (www.guidelines.com) or the APTA Web site (www.apta.org) leads agencies to multiple best practice components necessary for providing patients with an effective fall prevention program. Homecare agencies may choose to develop a plan that includes:

• A review of agency culture and assessment of current practice

• A review of evidence-based practice to support incorporation of fall policy and procedures, to include fall risk assessment, fall risk discipline triggers, fall safety checklist, and a fall prevention plan

• Selection of a qualified program lead who will support education and implementation

• Education of and involvement of all staff

• Implementation and measurement of compliance with program policy and procedure

• Use of tools such as Timed Up and Go Test, Berg Balance Test, Dynamic Gait Index, and Tinetti Balance Assessment Tool

Test and measures

• Timed Up and Go is used to screen individuals prone to falls and requires that the patient be able to follow directions. A score of 13.5 seconds identifies fall risk in older adults.

• Berg Balance Scale is a 14-item scale designed to measure balance. A score of less than 45 identifies older adults at risk of falling.

• Dynamic Gait Index is used to assess the ability to modify gait to changes in tasks in the older adult. A score of less than or equal to 19 signals a risk for falls in older adults.

• Tinetti Performance Oriented Mobility Assessment is a task-oriented test that measures gait and balance. A combined score of less than 19/28 is significantly predictive of falls in older adults.

Using a best practice format, the 2005 National Quality Improvement/Hospitalization Reduction Study delivered a homecare industry report that focused on generating insights on optimal ways for agencies to improve their hospitalization rates. The study investigated practices of the top 10% of agencies in the United States; fall prevention was listed as the No. 1 strategy for reducing hospitalizations.

This post was adapted from the book, OASIS-C Process Measures: A Program for Best Practices Implementation, by April Perry, RN, APN, MEd, Laurie Salmons, RN, BSN, and Bobi Rose, RN, BSN, CWCN, CCCN.