Fall Risk Screen Refresh: Updating and Standardizing the Fall Risk Screen

Purpose: The purpose of the fall risk screen documentation tool is to ensure standardized documentation of the patient’s fall risk and promote clinician knowledge of strategies to prevent future falls in the outpatient clinic setting.

Background/significance: Falls are known to be one of the leading causes of injuries among older adults, adults aged 65 and over. The academic medical center’s operational plan includes goals to decrease ambulatory care falls with injury. Historically, ambulatory care clinics utilized a fall risk screen within the electronic health record (EHR) that was originally developed for the inpatient setting. This screen did not fully capture the future risk of falls specifically for patients in the ambulatory care clinics. Additionally, the screen did not receive a formal review by the ambulatory care fall risk prevention committee. The ambulatory care fall policy was recently modified to increase the frequency of older adults' fall risk screening. With increased screenings, the clinical staff are more aware of the patient’s risk of falling. Once the ambulatory care fall policy was updated, the committee reviewed the available fall risk screens found in the EHR and discovered gaps in the existing fall risk screens. The CDC also provides the stopping elderly accidents, deaths, and injuries (STEADI) initiative resources to assist healthcare systems with mitigating and eliminating factors that lead to accidents, injuries, and death for older adults.

Description: With the assistance of the electronic medical record (EMR) team, a new fall risk screen was developed based on the current policy and vetted by the ambulatory care fall risk prevention committee. This new fall risk screen included screening questions from the STEADI algorithm for fall risk screening, assessment, and intervention among community-dwelling adults 65 years and older. By incorporating the CDC’s STEADI initiative tools and clinic-related fall prevention interventions, the new fall risk screening tool was created to be a more comprehensive tool that is better suited for encouraging fall risk prevention interventions in the outpatient setting. The tool provides physicians and advanced practice practitioners with appropriate documentation of the patient’s risk for falls.

Evaluation/outcome: With the new fall risk screen documentation tool available to clinic staff, users report an increased preference for the new fall risk screening tool when compared to the previous fall risk screening tool. The new tool continues to be promoted and socialized to non-hospital-based clinics through clinic in-services and presentations in ambulatory care practice committees. Although a new fall risk screen tool was created, the past fall risk screens remain available in the EHR. To improve the standardization of documentation tools, we plan to introduce the new screen to hospital-based clinics too. Also, the EMR team is currently developing a report to capture the utilization of the new fall risk screen. With this data, we can better understand how many patients are being screened and if there has been a reduction in falls in the outpatient setting.