Ambulatory Providers: Changes to annual Falls Risk Assessment

Beginning Feb. 2, the Ambulatory annual Falls Risk Assessment will be updated within the Visit Navigator for Ambulatory Clinics. (Note: This change only applies to the Falls Risk Assessment in Epic@UNC Ambulatory - not Inpatient.)

The new Ambulatory Falls Risk Assessment follows the recommendations from a joint collaboration between the CDC and the Stopping Elderly Accidents, Deaths & Injuries (STEADI) committee, and has been pilot-tested in two primary care clinics (UNC Internal Medicine and Orange Family Medical Group).

This simple, evidence-based, three-question falls risk assessment identifies patients who are at an increased risk for falls and need a more thorough evaluation of gait, strength and balance:

  • Have you fallen in the past year?
  • Do you feel unsteady when standing or walking?
  • Do you worry about falling?

In addition to new Falls Risk Assessment questions, a new Falls Risk Assessment Due alert banner will display in the Rooming activity when a patient age 65 and older has not had a Falls Risk Assessment performed in the past year, thus satisfying an important PQRS quality measure.

Last, a new system DotPhrase (linked to a discrete data element) will be available to document interventions taken and a plan of care for patients at increased risk for falls.

See the updated Ambulatory Falls Risk Assessment Tip Sheet for details on:

  • Updated Falls Risk Assessment in Visit Navigator
  • New Annual Falls Risk Assessment Due Banner Alert (patients age 65 and older)
  • New system DotPhrase (.FALLSPOSITIVE) for documenting interventions and plan of care

BPA piloted in February 2016

Please note: In February 2016, the two pilot clinics will begin testing a Best Practice Advisory (BPA) that will prompt providers to consider appropriate interventions and develop a plan of care for patients who answer “Yes” to any of the questions of the Falls Risk Assessment.

Until the pilot testing is complete and the BPA can be activated broadly, each clinic will currently need to determine how best to communicate that a positive assessment has occurred and develop a plan of care for patients at increased risk. The system DotPhrase can provide guidance on developing a plan of care.

Falls Risk background & highlights

Falls Risk screening is one of the top Patient Safety Measures tied to Physician Quality Reporting (PQRS) results. Failure to annually screen patients for falls risk presents UNC with a potential Medicare financial penalty; in addition, corresponding Physician Compare (Medicare’s public quality performance website) results will be negatively impacted.

As the leading cause of both fatal and nonfatal injuries for older adults, falls are one of the most common and significant health issues facing people aged 65 years or older. Older adults are five times more likely to be hospitalized for fall-related injuries than any other cause-related injury.

It is estimated that one in every three adults aged 65 years or older will fall each year. In those over age 80, the rate of falls increases to fifty percent. Falls are also associated with substantial cost and resources utilized, approaching $30,000 per fall hospitalization.

Identifying at-risk patients is the most important part of management, as applying preventive measures in this vulnerable population will have a profound effect on public health. Providers who routinely see older adults on a recurring basis have a pivotal role in screening these patients for risk of falls, and applying preventive strategies for patients at risk.

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