Impact of a falls menu-driven incident-reporting system on documentation and quality improvement in nursing homes

Purpose: Data from incident-reporting systems have been used successfully in disciplines other than health care to improve safety. This study tested the effect of a falls menu-driven incident-reporting system (MDIRS) on quality-improvement efforts in nursing homes. Design and Methods: Following instrument development and testing, the intervention occurred over a 4-month period in three intervention nursing homes using the MDIRS matched with three homes using their existing narrative incident report to document falls. Data on fall incidents were collected from facility incident reports, and comparisons in incident-report documentation were made between the intervention and control groups. The minutes from quality-improvement meetings were examined to see how incident-report data were used for fall-prevention strategies. Results: Almost one third of nursing home residents among the six facilities fell during the 4-month study period. Intervention nursing homes had significantly better documentation of fall characteristics on the incident reports than did the control nursing homes. Although only one nursing home fully implemented the MDIRS intervention, all three facilities identified strengths of the system. Implications: The MDIRS can have a significant impact in improving how nursing staff assess residents following a fall incident. Traditional narrative methods of documenting adverse incidents are time consuming and may not yield sufficient and accurate data. This model has the potential to enhance quality-improvement efforts and augment the current system of adverse incident reporting in nursing homes. Key Words: Accidental falls, Medical errors, Medical informatics, Reporting system, Quality assurance