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Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes

Cary, Michael P. Jr PhD, RN; Hall, Rasheeda K. MD, MBA, MHS; Anderson, Amber L. MPH; Burd, Andrew BA; McConnell, Eleanor S. PhD, RN; Anderson, Ruth A. PhD, RN; Colón-Emeric, Cathleen S. MD, MHS

doi: 10.1097/HCM.0000000000000192

We sought to understand strategies reported by members of the nursing home management team used to prevent falls in short-stay nursing home patients. Using Donabedian’s model of structure, process, and outcomes, we interviewed 16 managers from 4 nursing homes in central North Carolina. Nursing home managers identified specific barriers to fall prevention among short-stay patients including rapid changes in functional and cognitive status, staff unfamiliarity with short-stay patient needs and patterns, and policies impacting care. Few interventions for reducing falls among short-stay patients were used at the structure level (eg, specialized units, workload ratio, and staffing consistency); however, many process-level interventions were used (eg, patient education on problem solving, self-care/mobility, and safety). We described several barriers to fall prevention among short-stay patients in nursing homes. From these descriptions, we propose three interventions that might reduce falls for short-stay patients and could be tested in future research: (1) clustering short-stay patients within a physical location to permit higher staff-patient ratios and enhanced surveillance, (2) population-based prevention interventions to supplement existing individually tailored prevention strategies (eg, toileting schedules, medication review for all), and (3) transitional care interventions that transmit key information from hospitals to nursing homes.

Author Affiliations: Duke University School of Nursing, Durham (Dr Cary, Ms Anderson, Mr Burd, and Dr McConnell); Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Medical Center (Drs Hall, McConnell, and Colón-Emeric); University of North Carolina School of Nursing, Chapel Hill (Dr Anderson); and Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham (Dr Colón-Emeric), North Carolina.

This study was supported by research grants from the National Institute of Nursing Research (5R01NR003178-13; 3R01 NR003178-1S1). M.P.C. is funded, in part, by UL1TR001117 and R24-HS022134. C.C.-E. is funded, in part, by 2P30AG028716-06 and K24 AG049077-01A1. R.K.H. is funded, in part, by R03AG050834 and UL1TR001117). R.A.A. is funded, in part, by P30NR014139.

The authors have no conflicts of interest to disclose.

Correspondence: Michael P. Cary, Jr, PhD, RN, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710 (

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