1. Leininger Group Members  Cara Nuss  Raechel Little  Tanya Robb, RN, BSN, CCRN  Tiffany Lemanski, RN, BSN, CMSRN

2.  Falls and related injuries continue to be an unsolved problem in inpatient and outpatient care areas as well as in the community at large.  Approximately 32% of community-dwelling individuals over the age of 65 fall each year. Americans over the age of 65 currently represent 12% of the population, which equates to approximately 35 million people. Unintentional injury is the fifth leading cause of death in the general population in the United States, and falls are the second most common cause of unintentional injury across ages.  According to a study by Hausdorff, et. al, in the community setting, fall-related injuries are the most common cause of death in the persons over the age of 65, resulting in 38.4 fall-related deaths per 100,000 individuals 65 years or older (Currie, 2006).

3.  Does initiating a fall risk assessment tools or education of staff (I) in outpatient care settings with adults (P) reduce the number of falls (O) than in outpatient care areas where no fall risk assessment or education is performed (C)?  With each of us having nursing experience, we have utilized multiple fall risk assessment tools and interventions in inpatient care settings. This topic sparked our interest because we wanted to know what interventions are being utilized with outpatient, high-risk populations to prevent falls.

4. Research data has shown us that the more risk factors that are apparent in patients, the higher the chance of injury from a fall. If we assess our patients and understand the risk factors to watch for, we can utilize appropriate resources to intervene early.

5.  Did the literature Review Answer our PICO question › Holistic programs had more success than specific tools for reducing outpatient falls › The main components of a successful fall prevention program are reduction of medical risk factors, exercise, training and motivation. › Training medical staff about successful fall prevention programs helps to reduce falls, however there is resistance among some providers.

6.  General Findings › Most of the successful fall prevention programs were time consuming and required professional involvement (OT, PT, RN) and required patient’s to perform excersises e at home. › Most of the successful fall intervention programs were administered in group settings with individualized follow ups and risk assessments. › Fall and Balance Clinics are effective for helping to reduce outpatient falls, however these sites are a new concept and not widely used in the Primary Care Setting. › There is currently no assessment tool in practice for outpatient hospital area’s such as the ER and Urgent Care Clinics. › There is no specific tool or program that is considered “standard practice” for reducing fall in the outpatient population.

7.  Three articles were level 1, and included two meta-analysis and one historical systematic review.  Two articles were lever 2, Randomized Controlled Clinical Trials.  Four Articles were level 3, and included non-randomized controlled trials  Two articles were level 4, and included cohort studies  Two Articles were level 5, and included descriptive analysis. Level of Research

10. Educating patients, families, and healthcare professionals about the major risk factors and implementing a fall risk assessment tool, will not only assess for possible risks now, but also prevent injury and death in the future. Fall Risk Factors

12. One way to utilize resources appropriately is to have social work organize a to have an occupational therapist to do an assessment at home, to determine if the home is safe, and free of injury risks of falling for the patient. This resource could be determined based on a risk assessment score that is done when the patient is seen in the outpatient setting.

15.  More quantitative primary research examining effectiveness of fall prevention programs in out patient settings-not just in the community  Research of particular tools used in out patient settings  are the tools for acute care appropriate for other settings?  Do primary care providers find it necessary to discuss falls with their patients?  Do nurses in out patient care settings consider the potential for falls among various populations?