The Quality Measure for Falls with Major Injury impacts the SNF Quality Reporting Program (QRP) and Five Star. It will also impact the Value Based Purchasing (VBP) program beginning in 2027. Falls can obviously also have a negative impact during a State Survey.
This measure is a look-back scan measure and is determined as follows:
How can we improve performance for this Quality Measure and decrease resident risk for falls?
Per the CDC’s Facts AboutFactsAbout Falls, 1 in 4 older adults fall each year and falling once doubles the chance of falling again. In addition, “one out of five falls causes a serious injury such as a broken bones or a head injury”. These facts make it clear fall prevention is critical for our residents’ health and well-being and for successful clinical and financial outcomes.
Start by analyzing policies and processes related to admissions, screenings, fall prevention, preventative devices, and environmental risk areas. It is also important to audit documentation for appropriate performance of assessments and interventions.
Here are a few ideas for fall prevention and quality measure success:
1. Complete a fall risk assessment with each resident and routinely complete fall risk assessments – admission, readmission, quarterly, with changes in status.
2. On admission, determine hand dominance (right or left), what side the resident prefers to get in and out of bed on, any one-sided weakness, and preferences for room set-up and ADL routines.
3. Immediately address identified fall risks.
4. Complete a Drug Regimen Review – 3 or more medications indicates an increased fall risk.
5. Initiate fall precautions for residents on high-risk medications (i.e., anticoagulants, antiepileptics, antihypertensives, diuretics, laxatives, psychotropics, vasodilators, glycemic medications, etc.).
6. Provide preventative devices and interventions with immediate instruction to direct care staff.
7. Ensure gait belts are readily available for transfers and mobility.
8. Ensure a preventative maintenance program is in place for mobility and safety devices.
9. Address vision issues and/or make sure vision aids are clean and in place.
10. Address hearing issues and/or make sure hearing aids are in working order and in place.
11. Make sure the residents’ footwear is in good condition.
12. Ensure the resident is properly positioned and repositioned according to the plan of care.
13. Assess pain and provide interventions as appropriate.
14. Manage continence.
15. Declutter resident rooms.
16. Provide appropriate levels of activity.
17. Individualize activity programs.
On the MDS, ensure fall history is being coded on admission/entry, or re-entry. Record number of falls since admission/entry, re-entry, or prior assessment. If indicated, code major injury for bone fractures, joint dislocations, closed head injuries with altered consciousness, or subdural hematoma.
It is also important to ensure staff are competent. Competencies should include assessment of fall risk, identifications of the need for fall prevention strategies, safe transfers and mobility, and proper coding of the MDS for falls.
Monitor success through chart audits, training, walking rounds by leadership, and team meetings. Be sure to include all team members from leadership to clinical staff to environmental services to maintenance. Together the Interdisciplinary team can make a significant difference with fall prevention.