Measurement is essential to monitoring success and helps guide your team towards your specific intervention goal. Measurement also tells us what's working and what's not, and provides evidence to inspire other healthcare providers to improve the quality of patient safety.
The measurement methodology and recommendations regarding sampling size referenced in this GSK, is based on The Model for Improvement and is designed to accelerate the pace of improvement using the PDSA cycle; a "trial and learn" approach to improvement based on the scientific method. Langley, G., Nolan, K., Nolan, T., Norman, C., Provost, L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, Second Edition, CA. Jossey-Bass Publishers. 2009.
It is not intended to provide the same rigor that might be applied in a research study, but rather offers an efficient way to help a team understand how a system is performing. When choosing a sample size for your intervention, it is important to consider the purposes and uses of the data and to acknowledge when reporting that the findings are based on an "x" sample as determined by the team.
The scope or scale (amount of sampling, testing, or time required) of a test should be decided according to:
- The team's degree of belief that the change will result in improvement
- The risks from a failed test
- Readiness of those who will have to make the change
Provost, Lloyd P; Murray, Sandra (2011-08-26). The Health Care Data Guide: Learning from Data for Improvement (Kindle Locations 1906-1909). Wiley. Kindle Edition.
Please refer to the
Improvement Frameworks GSK (2015) for additional information.
Measurement Worksheets (Measures) and Data Collection Forms (DCF)
|Aggregate data (monthly)||De-identified Patient-level data (daily)|
|Numerator and Denominator||Multiple data elements|
|||Roll-up to Measurement Worksheets|
Falls Prevention Audit
The tool is designed for use in Acute, Long-Term, and Home Care, Supportive Living and Rehab and was developed to allow organizations to assess the quality of their falls prevention and injury reduction practices and determine the areas requiring quality improvement(s).
DCF (Audit) Question||
Roll-up to Measures|
|A. Type of Falls Risk Assessment performed on Admission||Falls-Acute/LTC 3|
|B. Was patient/resident/client designated "at risk" for Fall and was risk status communicated?||Falls-Acute/LTC 10|
|C. Medication review completed?||Falls-Acute/LTC 11|
|D. Pt. has documented Falls Prevention/Injury Reduction Plan||Falls-Acute/LTC 5|
|E. Completed Falls Risk Assessment following a significant change in medical status||Falls-Acute/LTC 12|
|F. Patient/Resident/Client is restrained at any time in this reporting period||Falls-Acute/LTC 6|
|G. How many times did the patient/resident/client fall in this reporting period||Falls-Acute/LTC 13|
|H. Was patient/resident/clients assessed for harm on discovery of fall?||Falls-Acute/LTC 14|
|I. Harm from Fall?||Falls-Acute/LTC 2|
|J. Completed Falls Risk Assessment following fall?||Falls-Acute/LTC 15|
|K. Monitored for 24-48 hours after fall?||Falls-Acute/LTC 16|
|L. Falls Prevention/Injury Reduction Plan Reviewed/Revised after Fall?||Falls-Acute/LTC 17|
Falls Prevention Audit Tools
Falls (Acute Care) Measures
|Falls-Acute 1 - Falls Rate per 1000 Patient Days||Reduce 40%||Outcome|
|Falls-Acute 2 - Percentage of Falls Causing Injury||Reduce 40%||Outcome|
|Falls-Acute 3 - Percentage of Patients with Completed Falls Risk Assessment on Admission||100%||Process|
|Falls-Acute 4 - Percentage of Patients with Completed Falls Risk Assessment Following a Fall or Change in Medical Status ||100%||Process|
|Falls-Acute 5 - Percentage of "At Risk" Patients with a Documented Falls Prevention/Injury Reduction Plan ||100%||Process|
|Falls-Acute 6 - Percentage of Patients with Restraints ||Reduce baseline||Process|
|Falls-Acute 7 - Fall Related INJURY Rate per 1000 Patient/Resident Days||Annual reduction of 40% or annual rate <= 0.3||Outcome|
|Falls-Acute 9 - Percent of patients designated "at risk"||Does Not apply||Process|
|Falls-Acute 10 - Percent of Patient designated 'at risk' and risk status communicated||100%||Process|
|Falls-Acute 11 - Percentage of patients with a medication review was completed||100%||Process|
|Falls-Acute 12 - Percentage of patients with Completed Fall Risk Assessment following Significant change in Medical Status||100%||Process|
|Falls-Acute 13 - Percentage of Patients with 2 or more falls||0%||Outcome|
|Falls-Acute 14 -Percentage of Patients Assessed for harm on discovery of fall||100%||Process|
|Falls-Acute 15 - Percentage of Patients with Completed Fall Risk Assessment following a fall||100%||Process|
|Falls-Acute 16 - Percentage of "Fallers" with monitoring in place for 24-48 hours after the fall||100%||Process|
|Falls-Acute 17 - Fallers with review or revision of Falls Prevention / Injury Plan after fall||100%||Process|
|Falls-Acute 18 - Fall Prevention Score||100%||Outcome|
|Falls-Acute 19 - Fall Management Score (after fall)||100%||Outcome|
Falls (Long Term Care) Measures
|Falls-LTC - Prevention of Falls in Long-Term Care Monthly Report||N/A||Information|
|Falls-LTC 1 - Falls Rate per 1000 Resident Days||Reduce 40%||Outcome|
|Falls-LTC 2 - Percentage of Falls Causing Injury||Reduce 40%||Outcome|
|Falls-LTC 3 - Percentage of Residents with Completed Falls Risk Assessment on Admission||100%||Process|
|Falls-LTC 4 - Percentage of Residents with Completed Falls Risk Assessment Following a Fall or Change in Medical Status ||100%||Process|
|Falls-LTC 5 - Percentage of "At Risk" Residents with a Documented Falls Prevention/Injury Reduction Plan||100%||Process|
|Falls-LTC 6 - Percentage of Residents with Restraints||Reduce baseline||Process|
|Falls-LTC 7 - Percentage of residents physically restrained daily on the most recent RAI assessment||At a minimum, to maintain at or below baseline||Outcome|
|Falls-LTC 8 - Injury Rate Due to Falls (Fall-Related INJURY) per 1000 Resident Day||Annual reduction of 40% or annual rate <= 0.3||Process|
|Falls-LTC 9 - Percentage of Residents Designated "At Risk"||Does Not Apply||Process|
|Falls-LTC 10 - Percentage of Residents Designated "At Risk" and Risk Status Communicated||100%||Process|
|Falls-LTC 11 - Percent of Residents With a Medication Review Completed||100%||Process|
|Falls-LTC 12 - Percent of Residents With Completed Fall Risk Assessment Following a Significant Change in Medical Status||100%||Outcome|
|Falls-LTC 13 - Percent of Residents With Two or More Falls||0%||Process|
|Falls-LTC 14 - Percent of Long-Term Care Residents Assessed for Harm on Discovery of Fall||100%||Process|
|Falls-LTC 15 - Percent of residents With Completed Fall Risk Assessment Following a Fall||100%||Process|
|Falls-LTC 16 - Percent of "Fallers" in Long-TermCare With Monitoring in Place for 24-48 Hours After Fall||100%||Process|
|Falls-LTC 17 - Percent of "Fallers" in Long-Term Care With Review or Revision of Falls Prevention/Injury Reduction Plan After Fall–||100%||Outcome|
|Falls-LTC 18 - Fall Prevention Score (Long-Term Care)||100%||Outcome|
|Falls-LTC 19 - Fall Management Score After a Fall (Long-Term Care)||100%||Outcome|
Types of Measures
Safer Healthcare Now! (SHN) has two types of measures for each of the interventions: process measures and outcome measures. Some interventions also have balancing measures and information measures. Below are examples of each.
Outcome measures - answers whether the team is achieving what it is trying to accomplish and articulates the picture of success. For example, if the team wants to reduce falls it should measure the number of falls.
Process measures - processes which directly affect the outcome are measured to ensure that all key changes are being implemented to impact the outcome measure. For example, the delivery of timely prophylactic antibiotics to reduce surgical site infection.
Balancing measures - answer the question whether improvements in one part of the system were made at the expense of other processes in other parts of the system. For example, in a project to reduce the average length of stay for a group of patients, the team should also monitor the percent of readmissions within 30 days for the same group.
Information measures - collect general details relative to the intervention.