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The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities

Appendix B. Forms and Training Materials (Appendix Contents)

Contents

  1. FMP Self-Assessment
  2. Tracking Record for Improving Patient Safety (TRIPS)
  3. FAX Alert
  4. Falls Assessment
  5. Falls Assessment Cue Sheet
  6. Mobility and Transfer Assessment
  7. Wheelchair Seating Assessment
  8. Unsafe Behavior Worksheet
  9. FMP Entry Log
  10. Primary Care Provider Fax Report and Orders
  11. Fall Interventions Plan
  12. Fall Interventions Monitor

Staff Materials

  1. Pre and Posttests for Inservice #1, Why Falls Happen
  2. Pre and Posttests for Inservice #2, How to Reduce Falls
  3. Pre and Posttests for Inservice #1, Why Falls Happen, Spanish
  4. Pre and Posttests for Inservice #2, How to Reduce Falls, Spanish
  5. Appendix B17: Handout for Inservice #1, Why Falls Happen in Nursing Facilities
  6. Appendix B18: Handout for Inservice #2, How to Reduce Falls in Nursing Facilities
  7. Appendix B19: Handout for Inservice #1, Why Falls Happen, Spanish
  8. Appendix B20: Handout for Inservice #2, How to Reduce Falls, Spanish

Primary Care Provider Handouts

  1. Facts and Flow Chart
  2. Suggestions for Further Assessment and/or Interventions
  3. Resources
  4. Letter to Primary Care Providers
  5. Ways Families Can Help Reduce Fall Risk
  6. Reducing Falls: A Safety Checklist for the Home
  7. Living Space Inspection
  8. Nursing Inspection List
  9. Engineer Inspection List
  10. Engineer Cane/Walker Inspection
  11. Engineer Wheelchair Inspection

Publication:
None

Page last reviewed December 2017
Page originally created February 2010

Internet Citation: Appendix B. Forms and Training Materials (Appendix Contents). Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapb.html

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