Prevention of Falls and Fall Injuries in the Older Adult

1 nursing Best Practice GuidelineShaping the future of NursingPrevention of Falls and Fall Injuries in the Older AdultRevised March 2005 Greetings fromDoris Grinspun Executive DirectorRegistered Nurses Association of Ontario It is with great excitement that the Registered Nurses Association of Ontario disseminatesthis revisednursing best practice guideline to you. Evidence-based practice supportsthe excellence in service that nurses are committed to deliver in our day-to-daypractice. The RNAO is committed to ensuring that the evidence supporting guidelinerecommendations is the best available, and this guideline has been recently reviewedand revised to reflect the current state of knowledge.

2 We offer our endless thanks to the many institutions and individuals that are making RNAO s vision forNursing Best Practice Guidelines (NBPG) a reality. The Government of Ontario recognized RNAO s abilityto lead this program and is providing multi-year funding. Tazim Virani NBPG program director with herfearless determination and skills, is moving the program forward faster and stronger than ever nursing community, with its commitment and passion for excellence in nursing care, is providing theknowledge and countless hours essential to the creation, evaluation and revision of each have responded enthusiastically by getting involved in nominating best practice champions,implementing and evaluating the NBPG and working towards an evidence-based practice comes the true test in this phenomenal journey: will nurses utilize the guidelines in theirday-to-day practice?

3 Successful uptake of these NBPG requires a concerted effort of four groups: nurses themselves, otherhealthcare colleagues, nurse educators in academic and practice settings, and employers. After lodgingthese guidelines into their minds and hearts, knowledgeable and skillful nurses and nursing students needhealthy and supportive work environments to help bring these guidelines to ask that you share this NBPG, and others, with members of the interdisciplinary team. There is muchto learn from one another. Together, we can ensure that Ontarians receive the best possible care every timethey come in contact with us. Let s make them the real winners of this important effort!RNAO will continue to work hard at developing, evaluating and ensuring current evidence for all futureguidelines.

4 We wish you the best for a successful implementation!Doris Grinspun, RN, MSN, PhD(cand), OOntExecutive DirectorRegistered Nurses Association of OntarioNursing Best Practice Guideline1 Program Team:Tazim Virani,RN, MScN, PhD(candidate)Program DirectorJane M. Schouten,RN, BScN, MBAP rogram CoordinatorHeather McConnell,RN, BScN, MA(Ed)Program ManagerStephanie Lappan-Gracon,RN, MNProgram Coordinator Best Practice Champions NetworkJosephine Santos,RN, MNProgram CoordinatorBonnie Russell,BJProgram AssistantCarrie ScottAdministrative AssistantJulie BurrisAdministrative AssistantKeith Powell,BA, AITWeb EditorPrevention of Falls and Fall Injuries in the Older AdultRegistered Nurses Association of OntarioNursing Best Practice Guidelines Program111 Richmond Street West, Suite 1100 Toronto, Ontario M5H 2G4 Website.

5 Heslin, RN, BScN, MScNTeam LeaderChief of nursing & Professional PracticeWest Park Healthcare CentreAssistant Lecturer, University of TorontoToronto, OntarioNancy Berdusco, RPNS toney Creek, OntarioLaurie Bernick, RN, MScN, ACNP, GNC(C)Assistant Lecturer, York UniversityToronto, OntarioLucy Cabico, RN, MS, ACNP, FNP, GNC(C)Clinical Nurse SpecialistBaycrest Centre for Geriatric CareToronto, OntarioDiane Carter, RNClinical Practice FacilitatorCambridge Memorial HospitalCambridge, OntarioSharon Mooney, RN, BA, MA, BSNN ursing Professional Development EducatorMcGill University Health CentreMontreal General HospitalMontreal, QuebecMireille Norris, BScPT, MD, FRCP(C)CSPQ, ABIM, MHScInternist/GeriatricianSunnybrook and Women s Health Sciences CentreToronto, Ontario Tim Pauley, PhD(C)Research CoordinatorWest Park Healthcare CentreToronto, OntarioJane M.

6 Schouten, RN, BScN, MBARNAO Program Staff FacilitatorBest Practice Guidelines ProgramRegistered Nurses Association of OntarioToronto, OntarioSandra Tully, RN, BScN, MA(Ed), ACNP, GNC(C)Acute Care Nurse PractitionerGeriatrics and Wound CareUniversity Health NetworkToronto Western HospitalToronto, OntarioSpecial AcknowledgementsRNAO also wishes to acknowledge the following for their contributions during theinitial and subsequent literature review:Diane M. Legere, RN, APCCN, BScN, MScN(C),for her work in quality appraisal of the literature;Abel Cheng, Hon. BSc,for his work in conducting the subsequent literature search; and Lori Murphy, BHSc, OT,for her work as interraterduring the critical review of the of Falls and Fall Injuries in the Older Adult2 Revision Panel Members (2005)Declarations of interest and confidentiality were requested from all members of the guideline revision panel.

7 Further details are available from the Registered Nurses Association of Best Practice GuidelineDevelopment Panel Members (2000)Kathleen Heslin, RN, BScN, MScNTeam & Chief nursing OfficerGrand River HospitalKitchener, OntarioNancy Berdusco, RPNC harge NurseTownsview Life Care CentreHamilton, OntarioLaurie Bernick, RN, MScN, ACNP, GNC(C)Clinical Nurse Specialist /Nurse PractitionerBaycrest Centre for GeriatricsToronto, OntarioDiane Carter, RNClinical Practice FacilitatorCambridge Memorial HospitalCambridge, OntarioNancy Edwards, RN, PhDProfessor, School of NursingDirector, CommunityHealth Research UnitCHSRF/CIHR nursing ChairUniversity of OttawaOttawa, OntarioClara Fitzgerald, , BEdEducation CoordinatorGrand River HospitalKitchener, OntarioFitzgerald ConsultingLondon.

8 OntarioOriginal ContributorsPrevention of Falls and Fall Injuries in the Older Adult4 AcknowledgementThe Registered Nurses Association of Ontario wishes to acknowledge the following individuals for their contribution in reviewing the nursing best practice guideline and providing valuable feedback during the initial development of the guideline (2000-2002):Faranak AminzadehResearch Associate, Geriatric Assessor, Regional Geriatric Assessment Program,Ottawa, OntarioThe Canadian Centre for Activity and AgingLondon, OntarioDr. Jocelyn CharlesSunnybrook and Women s College Health Sciences Centre, Toronto, OntarioCouncil for London SeniorsLondon, OntarioDr. Richard CrillyAssociate Professor, Department of Geriatric Medicine, University of WesternOntario, London, OntarioMary FoxNurse Manager, Baycrest Centre for Geriatric Care, Toronto, OntarioPam HolidayFalls and Mobility Network Centre for Studies in Aging, Sunnybrook andWomen s College Health Sciences Centre, Toronto, OntarioDr.

9 Barbara LiuGeriatric Medicine and Clinical Pharmacology, Sunnybrook and Women s College Health Sciences Centre, Toronto, OntarioDr. Alan MillsClinical Coordinator, Pharmacy Department, Baycrest Centre for Geriatric Care,Toronto, OntarioGail MitchellChief nursing Officer, Toronto, Sunnybrook Regional Cancer Centre, Toronto, OntarioJudy MurrayClinical Nurse Specialist, Regional Geriatric Program, Providence Centre,Toronto, OntarioSandra VesselYork Region Health Services Department, Markham, OntarioRNAO sincerely acknowledges the leadership and dedication of the nurse researchers who directed the evaluationphase of the nursing Best Practice Guidelines Project. The Evaluation Team was comprised of:Principal Investigators:Dr.

10 Nancy Edwards, Dr. Barbara Davies University of OttawaEvaluation Team Co-Investigators:Dr. Maureen Dobbins, Dr. Jenny Ploeg, Dr. Jennifer Skelly McMaster UniversityDr. Patricia Griffin University of OttawaRNAO also wishes to acknowledge Valleyview Home for the Aged in St. Thomas, Ontario, for its role in the pilot testingof the guideline during its initial development. 5 Prevention of Falls andFall Injuries in the Older AdultDisclaimerThese best practice guidelines are related only to nursing practice and not intended to take into accountfiscal efficiencies. These guidelines are not binding for nurses and their use should be flexible toaccommodate client/family wishes and local circumstances.