1. Quality Indicators in Residential Aged Care Services (RACS) Falls Indicator

2. What are the Victorian Residential Aged Care Quality Indicators all about ? The online resource:  Enhances knowledge of residential aged care QIs  Explains how to use them as part of your improvement toolbox 2 Why?  Helps residential aged care facilities monitor and focus on areas of high risk to residents  Improves resident quality of care and quality of life

3. 1. The What: What do we want to achieve by monitoring falls? Know the proportion of your residents with falls and falls-related fractures, trends, and the scope of the issue so you can take action to:  Reduce the level of resident harm when falls do occur  Implement strategies for preventing falls Recommended reference range Falls and fall-related fractures per 1,000 occupied bed days Quality Indicators in RACS Resource: Falls3 MeasuresLower target rate Upper limit rate Falls 3.311 Falls resulting in fractures 00

4. 2. The Why: Why is monitoring falls important? Quality Indicators in RACS Resource: Falls4  Falls can be prevented. However up to 50% of older people living in residential aged care services fall every year, with 40% experiencing recurrent falls.  Residents are also up to five times more likely to fall than those who live in the community. The proportion of residents with a diagnosis of dementia who fall has been reported as even higher. Approximately 20–32% of older people who fall will experience a fall-related fracture. 84.8% of fall-related deaths occur in people who are aged 70 years and over. The hip is the most common site of fall-related fracture. People aged 80 years or more are at the highest risk of falls and fractures. This age group represents the highest proportion of residents in aged care. Adverse events or harm associated with falls include:  death  fracture  decreased independence  increased functional decline  anxiety and fear of falling

5. 3. The How: How to collect and report this indicator How many/how often? Two measures for falls Every Quarter Using audit and incident data Quality Indicators in RACS Resource: Falls5 How do you collect and report the data? Audit resident records Review incident data If a fall has resulted in more than one fracture, record all fractures Record on data recording sheet with comments Exclude: falls and fractures that occur away from the aged care facility Include respite residents Quick tips for accurate data collection  Look beyond incident reports  Review each resident’s progress notes monthly  Check if there is a subsequent fracture identification  Correlate with incident reports. Fractures may be identified after a fall has already been reported.

6. 4. Definitions are important! A fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level. (World Health Organization, and Safety and Quality Council Guidelines for preventing falls and harm from falls in older people.) A fracture is traumatic injury to a bone in which the continuity of the bone tissue is broken. If a resident is found on the floor or ground, assume they have fallen (unless they are cognitively unimpaired and can confirm that they put themselves there on purpose). Note that a fall-related fracture can be located on any area of the individual’s body, and is not exclusive to areas traditionally associated with falls such as the hip. See the QIs Resource Materials for more detail – and supporting evidence. Quality Indicators in RACS Resource: Falls6

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8. 1.True or False: Falls can cause death  True  False 2. Residents to be excluded from the falls indicator data collection are: A.Respite residents B.Residents receiving end of life palliative care C.Residents with a history of falling D.None of the above Quality Indicators in RACS Resource: Falls8 Quiz

9. 3. True or False: The Falls indicator can be collected using incident reports only  True  False 4. Falls with fractures are counted: A.If the fracture is recorded at the time of the fall B.If the fracture is recorded after subsequent investigation C.If the progress notes record a possible fracture D.If the resident’s family has complained Quality Indicators in RACS Resource: Falls9 Quiz

10. 5. True or False: Aged care Residents are at much higher risk of falling than older people living alone in the community  True  False 6. The upper limit rate of the reference ranges for falls is 11 per 1000 bed days. If your organisation’s rate is higher than this, it means: A.Your falls-related care may sub-optimal B.You may have a problem with the way falls are counted C.You should investigate to see if there is a special cause D.All of the above Quality Indicators in RACS Resource: Falls10 Quiz

11. How did you go? Quality Indicators in RACS Resource: Falls11 Quiz

12. Using Quality Indicators to make a positive difference to resident care Quality Indicators in RACS Resource: Falls18 End of Falls Indicator

13. Quality Indicators in RACS Resource: Falls13 To receive this publication in an accessible format email acqiu@dhhs.vic.gov.au Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, December, 2015 Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. ISBN 978-0-7311-6825-5 (Online) Available at www.health.vic.gov.au/ageing-and-aged-care/residential-aged-care/safety-and- quality/workforce-training-development/online-training