Eastern Oklahoma VA Health Care System
VA Innovation Receives International Recognition
Among seniors and other at-risk individuals, falls are common and a major cause of injury and premature death.
Approximately one-third of all seniors aged 65 years and older are injured in falls each year.
To help prevent falls among seniors and other at-risk individuals, VA screens every patient to determine their risk for falling and provides grab bars, walking canes and wheelchairs for those at risk.
Jack C. Montgomery VA Medical Center (VAMC) has led the way in the effort to reduce falls and launched a new pilot program in 2006, which changed the way patients were screened during outpatient appointments.
Previously, the medical center used the Morse Fall Risk Assessment, which is still considered the 'Gold Standard' for inpatient care. However, the medical center did not consider the Morse Fall Risk Assessment to be ideal for the outpatient setting, because the screen did not allow for the addition of notes about potential risk factors.
The medical center asked registered nurses Sally Meador, Roberta Jones and Marsha Heasley to develop a more ideal screening method. They met once a week for 8 months and created the Outpatient Fall Risk Assessment Screen, which was specifically designed for outpatient appointments.
“We were challenged to come up with something better than the Morse Fall Scale,” said Meador. “The response to the challenge was, ‘do you think you can do better’?”
Meador, Jones and Heasley researched the work of Dr. Lawrence Rubenstein who designed the 10 Foot Get Up and Go Test. The registered nurses adapted the 10 Foot Test and created a new electronic form, which allows the addition of comments.
During the screen, nurses carefully observe patients as they walk into the clinic to identify any gait or balance issues, determine whether they’re at risk for falling and ask the patient about any recent falls.
Once a nurse determines that a patient is at risk, he or she completes the electronic form and the primary physician receives an immediate alert through VA’s electronic medical record system.
What began as a pilot program is now being used by many VA medical centers and hospitals around the world.
“We did it for the love of the project,” said Meador. “We took the pieces already in place, made modifications where they were needed, included all the necessary elements and created an award winning process. With a few clicks on the computer we also created something that is useful for patient care and a leader in its field.”
In October 2010, the Outpatient Fall Risk Assessment Screen received international recognition during The Fourth European Nursing Congress: Older Persons: The Future of Care, which took place in Rotterdam, Holland. Meador traveled to Rotterdam and demonstrated the assessment screen.
“It was just an honor to get to go and to have it accepted,” said Meador. “It was a very big honor. People from all over the country and now all over the world are asking to look at it. I really enjoy that.”
The Assessment Screen was also recognized at the Transforming Falls Prevention Conference in Florida in 2008 and 2009 and won the Sharon Coleman Nurse Informatics Award, awarded by the Veterans Health Administration Vista e-Health University, which recognizes innovative projects that combine nurse practice and computer application.
The Department of Defense also used the Assessment Screen to design a fall risk assessment for the Army, Navy, Air Force and Marines in the Primary Care Setting.