Registered Nurses´ Association of Ontario

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Practice Recommendations: 

Assessment 

Recommendation
1.0 Assess fall risk on admission.

Risk Factors and Associated Odds of Falling
1.1 Assess fall risk after a fall.

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Intervention 

Recommendation
2.0 Tai Chi: Tai Chi to prevent falls in the elderly is recommended for those clients whose length of stay (LOS) is greater than four months and for those clients with no history of a fall fracture.

There is insufficient evidence to recommend Tai Chi to prevent falls for clients with LOS less than four months.
2.1 Exercise: Nurses can use strength training as a component of multi-factorial fall interventions; however, there is insufficient evidence to recommend it as a stand-alone intervention.
2.2 Multi-factorial: Nurses, as part of the multidisciplinary team, implement multi-factorial fall prevention interventions to prevent future falls.
2.3 Medications: Nurses, in consultation with the health care team, conduct periodic medication reviews to prevent falls among the elderly in health care settings.

Clients taking benzodiazepines, tricyclic antidepressants, selective serotonin-reuptake inhibitors, trazodone, or more than five medications should be identified as high risk.

There is fair evidence that medication review be conducted periodically throughout the institutional stay.
2.4 Hip Protectors: Nurses could consider the use of hip protectors to reduce hip fractures among those clients considered at high risk of fractures associated with falls.

However, there is no evidence to support universal use of hip protectors among the elderly in health care settings.
2.5 Vitamin D Nurses provide clients with information on the benefits of vitamin D supplementation in relation to reducing fall risk.

In addition, information on dietary, life style, and treatment choice for the prevention of osteoporosis is relevant in relation to reducing the risk of fracture.
2.6 Client Education All clients who have been assessed as high risk for falling receive education regarding their risk of falling.
3.0 Environment Nurses include environmental modifications as a component of fall prevention strategies.

Education Recommendations

Recommendation
4.0 Education on the prevention of falls and fall injuries should be included in nursing curricula and on-going education with specific attention to:
  • Promoting safe mobility;
  • Risk assessment;
  • Multidisciplinary strategies;
  • Risk management including post-fall follow-up; and
  • •Alternatives to restraints and/or other restricted devices.

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Organization and Policy Recommendations

Recommendation
5.0 Nurses should not use side rails for the prevention of falls or recurrent falls for clients receiving care in health care facilities; however, other client factors may influence decision-making around the use of side rails.
6.0 Organizations establish a corporate policy for least restraint that includes components of physical and chemical restraints.
7.0 Organizational Support: Organizations create an environment that supports interventions for fall prevention that includes:
  • Fall prevention programs;
  • Staff education;
  • Clinical consultation for risk assessment and intervention;
  • Involvement of multidisciplinary teams in case management; and
  • Availability of supplies and equipment such as transfer devices, high low beds, and bed exit alarms.
8.0 Medication Review: Implement processes to effectively manage polypharmacy and psychotropic medications including regular medication reviews and exploration of alternatives to psychotropic medication for sedation.
9.0 RNAO Toolkit:Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation.

Organizations may wish to develop a plan for implementation that includes:
  • An assessment of organizational readiness and barriers to education.
  • Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process.
  • Dedication of a qualified individual to provide the support needed for the education and implementation process.
  • Ongoing opportunities for discussion and education to reinforce the importance of best practices.
  • Opportunities for reflection on personal and organizational experience in implementing guidelines.
    • In this regard, RNAO (through a panel of nurses, researchers and administrators) has developed the Toolkit: Implementation of Clinical Practice Guidelines based on available evidence, theoretical perspectives and consensus.

    The Toolkit is recommended for guiding the implementation of the RNAO guideline Prevention of Falls and Fall Injuries in the Older Adult.

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Registered Nurses´ Association of Ontario