Your fall prevention plan is executed perfectly, with exercise classes, non-slip floors, walking aids, and adequate lighting. So why aren't your fall rates where you want them?

It takes more than a safe environment and great staff to slash incident rates and avoid potential litigation. Better QA reporting and accessible, clear incident data could give you the power to prevent falls and improve the care you provide in your communities.

A study conducted by the Office of the Inspector General (OIG) from 2008-2012 identified that an estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care.

Most senior living organizations still attempt to track adverse events by keying them into Microsoft Excel spreadsheets. Tracking, managing, and reporting adverse events is mission-critical to senior living facilities and their parent organizations.

EHRs are patient-focused, while adverse event management is facility-focused. So, quality and nursing staff take matters into their own hands to handle adverse event tracking in spreadsheets. 

It intrigues me that someone like Muhammed Ali, who was highly respected for his contributions to the boxing world and his philanthropism, could succumb to septic shock! As we educate our caregivers on the importance of early detection and prompt medical treatment, this is a good reminder that even with the highest level of care, an elderly, compromised body is at risk. None of our residents is protected from sepsis—there is no immunization, only early detection and prompt treatment.

About 20 years ago, during a consulting visit to a long term care community, the Director of Nursing was sitting at a computer (rare back then) entering incident data into a spreadsheet. When I asked what she was doing, she said, "My QA reports are due today and I haven’t input any of the incident data. I usually take the reports home and update the spreadsheet, but I ran out of time."

When I reviewed the spreadsheet it was pretty impressive. It allowed me to identify trends and produce graphs and charts. It was all that and a bag of chips!

But there are serious issues with spreadsheets. Let’s talk about the pitfalls of using spreadsheets for tracking and trending incidents and accidents in our communities.

Providing exceptional care in an SNF or ALF today involves much more than simply having good care providers and staff. If you’re striving to decrease the number of falls and other incidents, you may need to usesome strategic thinking and investigative work. In particular, you may be looking for valuable information about patterns in the number and type of incidents, and how these could be corrected with the right number of nurses at the right time.

Your organization manages adverse events much like everyone else. Someone, likely a pretty high-functioning nurse, accumulates paper incident reports manually or from your EHR system. They periodically type them into a spreadsheet, then sort them and count the different types of incidents by community. They do a pretty good job of it, even though they complain that they aren’t very good at Excel, that some buildings don’t report consistently, and that they can’t get anybody’s attention with the results that are often murky at best compared to benchmarks that they can’t find.

Let’s put aside the qualitative aspects of incident reporting and let’s overlook the most important aspect of your current incident reporting and adverse event management process—that it doesn’t work as well as it should and could. Let’s focus on one simple thing: how much does it cost you?

There are top performers in every industry and every sport, and they have remarkable similarities. Sure, they have talent, but they also approach their work in the same ways and with the same tools.

I was just watching the U.S. Olympic Trials, which was dramatic and exciting. For most of the athletes, it was their best chance to go to the Olympic Games, to be an Olympian. No matter if they were a high jumper, a sprinter, a wrestler or a gymnast, after their event—when the microphone was placed in front of them, every one of them said the same thing: “I worked so hard to get here.”

Have you ever had an adverse event happen in your community where you identified that a deficient practice may have contributed to, or failed to prevent, the incident? This may surprise you, but CMS understands that this can happen and they're willing to give you an opportunity to avoid citations! Shocking but true, back in October 2005 a memo was published by CMS outlining the History of Past Non-Compliance (HPNC) process (www.cms.gov).

It's a well-known fact that many resident falls aren't preventable. But it's still our responsibility to decrease the risk of significant injuries related to falls.

A large study from Canada showed that frail, elderly patients face a significantly increased risk of mortality in the year after undergoing major elective, non-cardiac surgery. Being frail before surgery substantially increases the risk of adverse postoperative outcomes and that frailty had the strongest impact on the risk of mortality after total joint arthroplasty.