canadian falls prevention curriculum · 3. to gain experience working in a collaborative manner on...

Canadian Falls Prevention Curriculum

E-Learning Course Workbook

January 2009

CFPC E-Learning Workbook

CFPC E-Learning Course Overview CFPC E-Learning Course Purpose WELCOME to a unique course designed to help prevent falls among older persons in community, residential and acute care settings. This course is designed to build on your previous training and experience in fall prevention and in caring for older persons through health service delivery or community programs. The purpose of this Course is to provide you with an opportunity to apply the five steps of the public health approach presented throughout the curriculum. This will be accomplished through the practical application of tools and concepts covered in each lesson to a specific fall prevention case study. The intent is to integrate this new information into regular, ongoing health care and community services for older persons. The course promotes a collaborative approach and encourages your communication and sharing of ideas with co-learners. This document is a companion to the e-learning presentation. It is intended for use to support your learning throughout the course completion. It is recommended that you print a copy of this workbook and use a pencil to record your responses as they may change as you progress through the course. E-Learning Course Objectives 1. To strengthen understanding of a public health approach and its

application to intervention implementation. 2. To gain experience in the application of a planning model to a fall

prevention problem. 3. To gain experience working in a collaborative manner on a fall

prevention issue with other e-learning participants.


You will choose one of the case studies presented in the CFPC e-learning course. As you work through the lessons, you will be asked to:

1. define the problem that you identify in your case study and re-work that problem statement into a goal for your fall prevention program,

2. identify risk factors in your case study and use them to develop your program objectives,

3. choose appropriate interventions and develop activities to implement these interventions,

4. develop an evaluation plan to measure the success of your program, and

5. respond to questions about your case’s social and policy context. Here you will need to draw from your own situation and create a context for your case study. Feel free to be creative!

Throughout the course, you will be given an example of each of the steps above, based on an example problem given in the first exercise. The questions in this workbook reflect the questions that are used in the discussion forums. It is mandatory that you contribute to the forums at specific points in the course in order to complete the project, but we encourage you to participate in all of the forums.

You must post in the discussion forums and process feedback on the following: For your chosen case study:

Problem Statement Goal Objectives Interventions Action Plan

These correspond to the boxed sections in this workbook. Your final goal for this course is the completion of the Program Implementation Worksheet. Support for completing each step of the Worksheet will come from other participants through the discussion forums and through feedback from the course facilitator. Insert these ideas in pencil on your Worksheet so that you can refine them as you work through the stages of the course.


At the end of the course, you will be required to email your final version of your Program Implementation Worksheet to be evaluated by the course facilitator to ensure that the plan is consistent with your selected case study, includes all steps of the program planning process, and reflects the social and policy context of your case study.


Canadian Falls Prevention Curriculum© (CFPC) Program Implementation Worksheet

Program Name: 1a) Problem Statement: 1b) Goal: 2. Objective #1:

Risk Factors(s): (circle one or more risk factors that apply to the target group addressed in the objectives)

Biological/Intrinsic Behavioural Social/Economic Environmental 3. Intervention #1: Intervention # 2: Best Practice Intervention(s): (circle two or more best practice categories to be addressed in the intervention(s)) Behaviour Change Education Equipment Environment Activity Clothing/Footwear Health Management 4. Action plan (see separate sheets)


Lesson 1: Defining the Problem E-Learning Exercise 1.1 Your case study is meant to represent a larger group with similar risks for whom you will be designing a prevention program. Based on the information in your case study, use your imagination to create a target population that will benefit from your prevention plan. a. After reading your case study, briefly describe the fall and injury issues for your older person.

b. Describe the population that he/she represents, e.g., age group, gender, level of frailty, and setting where he/she is falling.

c. What is your definition of a fall?

d. Where would you find information to determine how large an issue this is within your context?


e. When you design your program to address these fall issues, what would success look like?

f. How would you know you have made a difference? Social and Policy context: answers to these questions will help identify activities that you will need to do as you develop your program (refer to your Resource Manual). g. What is the meaning of the fall for your older person and their

family? If your older person, or his/her family/caregivers, do not believe that these falls can be prevented, what will you need to do to get their interest and buy-in?

h. Your case study gives you a suggestion of who you are – now think

about others who you need to have at the table now? Do you want to tackle this problem on a population level (national, provincial, territorial, regional, etc.) or an individual level (individual fallers, community group or defined setting)? Note: consider addressing the immediate problem and “upstream” prevention.


E-Learning Exercise 1.2 Problem Statement: a. Based on Exercise 1.1 now write a problem statement that includes

the fall issue and your target population that you will focus on for the Program Implementation Worksheet.

Example problem statement: “Over the past ten years, there has been an increasing number of in-patient hip fractures from falls (defined problem statement) among persons aged 55 and older in the five acute-care hospitals in the Toronto area (target population).” Your Problem Statement (including the fall issue and target population – remember, the individual in your case study should be representatives of your target population):

b. What types of data will you require to measure the scope of your

fall issue? And where would you get these data? (refer to Lesson 1 for examples) How would you use these sources to measure change in risk factors?


Data Source(s): Example: For the problem statement above, you would use in-hospital incident reports for falls resulting in hip fractures and track changes over time. Note: hospital separation records do not provide enough detail to determine location by ‘in-hospital’ setting, only by institutional settings in general. c. Do you have all the information you need to build a business case

to address this problem, if not, what else will you need and how will you get it?

Goal Statement: Turn your problem statement into a goal statement for your project. Goals: are broad statements of ideal future conditions with the expectation of improvement expressed over the long term. A goal is not expected to be measurable, but it should be supported by well-stated objectives that are measurable. Goals should determine the overall direction of the efforts, but not the activities that will be implemented. Example goal statement: to reduce the incidence of hip fractures from falls in acute-care settings. Your goal:


Lesson 2: Identifying Risk Factors E-Learning Exercise 2.1 a. Review your case study and the population it reflects, and identify

at least 5 possible risk factors with one or more from each of the following categories:

Biological Behavioural

Social/Economic Environmental

b. Note with an asterisk (*) which of these factors are amenable to change. Underline those which are within your mandate to address. c. Social and Policy context: What are perceptions of the fall and

injury prevention problem in your community/setting? What will you need to do to ensure they have an accurate perception of the problem?


Exercise 2.2 Objectives: Objectives: are statements of change sought in a fall-related problem in terms that are measurable, time-limited, achievable and specific to risk factors of a given target population. Objectives must be specific to what you plan to do, for whom, and in what time period. The more focused and specific the objectives, the better they will be for providing direction to your program implementation. You may have many objectives to address a single goal.

SMART is an acronym that outlines the key elements of good objectives:

S Specific M Measurable A Attainable R Relevant T Time-bound/Trackable

Before describing your objective, consider the risk factors listed above that apply to your specific target group. Which ones will you address in this program? This will link you back to the evidence provided in Lesson 2 to support your choices. Make sure that your objectives are measurable. Example Objective: To reduce the number of in-patient hip fractures by 20 per cent over the next five years among persons aged 55 and over admitted to five acute care hospitals in the Toronto region. Example risk factors:

Biological: over 55, possibility of osteoporosis or osteopenia; has an acute illness

Behavioural: history of falling Social/economic: possibility of poor diet due to low income Environmental: obstacles and tripping hazards in the hospital

room and in corridors Now create one or two objectives based on your risk factors identified above.


Your objectives:


Lesson 3: Examining Best Practices E-Learning Exercise 3 a. What stage is your target audience of older persons at in their

“readiness to change”? Their family and caregivers? Practitioners? Policy Makers? The broader community? (refer to Lesson 3 in the Resource Manual for “Readiness for Change” stages).

b. Identify possible intervention strategies that may be used to

address your identified risk factors and objectives. Refer to the BEEEACH model to frame your responses.

Behaviour Education Equipment Environment


Activity Clothing and Footwear Health Management Example using the BEEEACH model:

Behaviour: wearing hip protector Education: educating staff as to the risk factors for falls in

acute settings, educating staff on screening tool, and the effectiveness of hip protectors

Equipment: hip protectors Environment: bed height, removal of bed rails, non-slip,

energy absorbing flooring, uncluttered path to washroom and uncluttered hallways with accessible hand rails

Activity: physical exercises Clothing and Footwear: correct fitting nightwear and

housecoats, slippers with appropriate soles Health Management: continence management, staffing re-

alignment for high fall-risk times of day, medication review and monitoring


c. What are the characteristics of your setting that will enhance or inhibit the implementation of some of these possible interventions? What will you need to do to create a climate that embraces your fall prevention interventions?

Interventions: d. Identify two interventions (from at least two of the best practice

categories of the BEEACH model) that you will further develop in the next exercise. These interventions should directly address your objective. Identify who might be involved in implementing this intervention (i.e. OTs, PTs, RNs, seniors centres, recreation centres etc.). See next page for boxed space to insert answer.

Example intervention: Supply hip protectors to all persons aged 55 years and over who are diagnosed to have osteoporosis or osteopenia and/or who have had a diagnosed fracture in the past five years. This example employs the best practice categories of: Behaviour Change and Equipment. This intervention would involve the older persons at risk to express a wish to reduce their risk through the use of hip protectors, management to provide the hip protectors, nursing staff to instruct on their use and monitor compliance, administrative staff to document use, and family members to provide support. Note, this is just one of a number of interventions to address this problem. Others might address other known prevention strategies for fractures, including general falls prevention, exercise, diet, sunlight exposure, medication use, etc.


Your Interventions: Intervention 1 and partners Intervention 2 and partners


Lesson 4: Implementing the Program E-Learning Exercise 4 Go back and review the work done in the first 3 lessons. Make any necessary changes to your Problem Statement, Goal, Objectives and Interventions and enter your revised versions into your Program Implementation Worksheet. Action Plan: Now develop activities for each of your interventions using the Action Plan. Leave the last column blank on Success Indicators and Methods, as this will be address in Lesson 5. Be sure to incorporate activities that you have identified to address your social and policy context. An example action plan follows and was reviewed in lesson 4 of the e-learning course.


Your Action Plan: Intervention 1 – Activities Specific

Target Group Time frame Responsible

Person(s) Resources Success

Indicators and Methods


Intervention 2 - Activities Specific Target Group

Time frame Responsible Person(s)

Resources Success Indicators and Measures


Example Action Plan: for lesson 4 and 5 Action Plan and Evaluation Activities Specific Target

Group Time frame Responsible

Person(s) Resources Success Indicators

and Methods Purchase hip protectors Screen for risk Administer hip protectors to those at risk Monitor falls, hip protector compliance and hip fractures Provide brochure to promote hip protector use

Equipment suppliers All those admitted to 5 hospitals aged 55 years and over Those aged 55 and over with osteoporosis or osteopenia and/or who have had a diagnosed fracture in the past five years. All those aged 55 and over admitted to 5 hospitals All those given hip protectors

Over next 3 months Upon admission to unit After screening Over 5 years with annual reports Over 5 years

Unit manager RN on duty RN on duty Manager, unit staff and administrative assistant Staff, patient and family

Hospital budget for purchase, shipping and storage Staff time, printing of screening tool, data entry of screening results Staff time, cleaning, storage, replacement cost for damaged products Staff time, printing, data entry, reports Brochure on hip protector benefits and proper use

Hip protector availability

Summary results of screening Compliance with

use of hip protectors

Method – chart Record; ward summary sheet, unit meeting reports

Fall reports Regular checks for

hip protector use Use at time of fall Number of hip

fractures Number of brochures given to patients and family members


Lesson 5: Evaluating the Program E-Learning Exercise 5 Answers to the following questions will guide the identification of success indicators for your project. a. What do you need to evaluate and why? b. Who needs this information? c. Think back to your answers to Exercise 1 d) and e) and identify the

success indicators and methods you will use to evaluate your project and fill in this column of your worksheet on the previous page. See the example above to prompt ideas.

Make sure your indicators will answer the following evaluation questions: 1) Did we do what we said we would do? 2) What did we learn about what worked and what didn't work? 3) What difference did it make that we did this work? 4) What could we do differently? 5) How do we plan to use the evaluation findings for continuous learning?


E-Learning Final Program Implementation Worksheet Review your “boxed” answers from each lesson, revise as necessary and insert them into the Program Implementation Worksheet. This worksheet, together with your Action Plan, will form the content of your final report. This final report will be submitted to the course facilitator in pdf format by email. The facilitator will review and give you helpful feedback in order to make your fall prevention program relevant and sustainable. Our hope is that on the completion of this course you can take your program plan to your work setting and begin implementation.

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