Background: Globally, falls are a major public health problem. Organizations worldwide are developing programs and guidelines to address falls, including the Prevention of Falls Network Europe (ProFaNE), and the American Medical Directors Association (AMDA) in the United States. The World Health Organization (WHO) reports an estimated 424,000 fatal falls occur yearly. Another 37.3 million falls per year are severe enough to require medical attention. The largest morbidity occurs in young adults, children, and people aged 65 and older. Older adults are at major risk for resulting long term care or institutionalization. Foreground: In the US, by 2030 approximately three million people over the age of 65 will be living in nursing homes. Between 50-75% of nursing home residents fall each year, causing significant morbidity/mortality. A local long term care facility (LLTCF) is a 78 bed long term care facility (LTCF) that has been under scrutiny by the State of Michigan, with a one star Medicare Quality rating based, in part, on the number of resident falls. EBP Framework: The PI utilized ECLIPSE framework for development of clinical questions, Schultz’s Clinical Scholar Model Evdience Based Practice (EBP) model, and Kotter’s Eight Step Process for Leading Change model to plan and organize the project. Methods: The goal was to facilitate provider behavior change to include implementation of the vitamin D screening component of the Fall and Fall Risk Clinical Practice Guideline of the AMDA. A three month retrospective chart review was completed after approval by the Rocky Mountain University IRB to identify whether providers at LLTCF were screening older adults for Vitamin D deficiency via laboratory analysis on admission to the facility. A pilot educational offering was conducted with providers. Feedback was obtained via training evaluation tool that rated participant knowledge prior to and following educational offering. A two month retrospective review of charts was then completed to assess provider behavior change to include screening of older adults for Vitamin D deficiency/insufficiency on admission to the LTCF. Descriptive statistics were used to compare pre and post seminar implementation of assessment for Vitamin D status. Findings/Results: Prior to the educational offering, 9.5% of residents were screened for vitamin D status upon admission to the LTCF. After the educational offering, the rate rose to 89.47% of residents screened, just shy of the 90% target. Secondarily, the fall rate at LLTCF diminished from 7.3 in 2011 to 4.7 in 2012. The first quarter of 2013 revealed a fall rate of 2.94. The underlying goal of the AMDA’s fall prevention clinical guideline, while not the focus of this study, has also been demonstrated in a reduction of fall rate at LLTCF. Conclusion/Recommendations: Based on the success of this project, it is recommended that the program be extended to the remaining providers of the Medical Group for implementation at the other 69 facilities across the State of Michigan for whom the group provides Medical Director services.
