Table 3.

Manager-reported Barriers to Fall Prevention among Short-stay patients with Reported Structural and Process Interventions that Might Address Them

Barrier to fall prevention in short-stay patients	Interventions: structure	Interventions: process
Rapidly changing functional status leads patients and families to attempt unsafe activities	Cluster short-stay patients on units with higher staffing ratios Co-locate rehabilitation staff on the rehab units Medicare regulations require comprehensive care planning: periodic MDS assessments (5-, 14-, 30-, 60-, and 90-day) State regulations require staff to document different fall prevention strategies	Early assessment of functional status within hours Patient/family education at admission Use your therapy staff as resources in falls prevention: therapy evaluation used to inform nursing staff of functional deficits Population-based strategies Scheduled toileting program
Patient abilities, daily patterns, needs are not known to staff	Improve EMR communication with hospital Improve effectiveness of technology used to determine when a patient falls Electronic systems used to collect and store fall-related incidents need to provide analytics (i.e., patterns, trends)	Initially classify all short-stay patients as high fall risk Communication of falls risk occurs via multiple mediums: electronic (e.g., internal email, hallway kiosks), oral (e.g., nurse to nurse, therapist to nurse, team meetings), and physical (e.g., resident care cards, better signage, and easy to understand wording) Patient/staff assignment consistency Training to improve value and detail of incident reporting Increase frequency (e.g., orientation, after falls, and identified trends) and type of training (e.g., therapy educates nurses on strategies to prevent falls among short-stay patients: proper seating, safe transfers, and facilitate patient’s movement through placing assistive devices in range for use). Environmental safety committee
High prevalence of delirium results in rapidly changing cognitive status		Focused medication review (admission)
Reimbursement policies result in discharge before residents are safe to be at home		Continuity of care: taking steps to transition the patient to a lower level of care Coordination with home health for continued rehabilitation services at home Patient education on use of assistive devices and maintaining safety while at home When discharge back to the community is unlikely: placement of short-stay patients within a semi-private room with anticipation of becoming a long-term care resident

EMR, electronic medical record; All other abbreviations can be found in Table 2.