New Quality Initiatives and Your Falls Risk Program: How Strong is Your Program?
Falls Risk Mitigation
Tracking data related to patient falls is vital to your agency so you can identify gaps in risk assessments necessary to prevent falls. Payor sources are looking at Home Health Compare standings and Star ratings. They know these are indicators in the challenging world of Value Based Purchasing.
Review your Falls Risk Program. Do you conduct a post review of any falls incident? Do the clinicians ask upon every visit if the patient has fallen or experienced any unsteadiness? Is there evidence of depression, muscle weakness, or problems ambulating?
Do you monitor which clinicians are involved with which patients who have fallen? Do you monitor what the follow up has been if a patient scores a 4+ on the Missouri Alliance for Home Care? Whatever tool your agency uses for Falls risk, be certain it is a standardized tool that is multifactorial and validated (CMS.gov, 2016).
One of the key areas to review, that cannot be stressed enough, is a thorough medication review.
How to improve your Medication Review
Once the number of medications has been recorded, has a decrease in that number of meds been explored with the physician? Is this documented in the clinical record? Recently, a hospitalist shared that upon reviewing a patient’s medications, he found four medications prescribed to handle symptoms the patient had experienced when taking three medications that had long since been discontinued.
If the patient is on psychotropic, diuretic, or cardiovascular drugs, have lower dosages been explored with the physician? Is the patient on more than one psychotropic drug? Have narcotics been prescribed for a patient on a psychotropic?
Have vitamins and supplements been discussed with the physician or pharmacist, as several herbals and vitamins are known to cause dizziness such as too much Vitamin A or too much or too little Vitamin D. Does the patient take a multi vitamin and Vitamin A supplement and eat several foods fortified with Vitamin A?
When was the patient’s last vision exam? Is the patient due to see their vision specialist soon? When was the last time their eyeglasses were reviewed and or updated?
What are the best exercise routine and balance exercises needed specifically for each patient? Could a PT referral reduce the risk of falling? What are activities the patient enjoys? If a strength or balance program is incorporated, is progress being evaluated routinely? Is there a history of peripheral neuropathy? Perhaps from a prior diagnosis that is no longer considered active?
Does your agency have a home safety checklist that reviews room by room potential hazards? Assist the patient to see that reducing clutter, improving lighting in hallways and stairwells, and installing handrails and grab bars strategically can be a long term investment in maintaining their independence.
Sometimes, just a refocus on a subject with personnel can increase awareness. The National Council on Aging has an in depth training program on Falls risk education for home health aides. In a Value based Purchasing environment, you may well see the resurgence of home health aide service in the home. Assist them to see the patient through a Falls risk lens.
Let’s focus on Falls Risk. CMS and other payors are focused. In a value based world, your care of each patient and their outcomes will be a key factor in your agency viability. Falls risk mitigation is good for everyone and can have a great moral, caring, and financial return on investment.
SourcesCenters for Medicare & Medicaid (2016). Quality Measures. CMS.gov. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIQualityMeasures.html