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Fall Prevention Program Checklist

This document is a checklist for evaluating a fall prevention program for implementation at a nursing home or aged care facility. It addresses needs assessment of the target population, available resources, program characteristics like training requirements and exercise components, implementation support, evaluation methods, and gets sign off from relevant parties. The checklist helps ensure the program fits the facility's needs, budget, and abilities while providing an effective intervention to reduce falls risk factors for elderly residents.

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Marz Ziko
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58 views3 pages

Fall Prevention Program Checklist

This document is a checklist for evaluating a fall prevention program for implementation at a nursing home or aged care facility. It addresses needs assessment of the target population, available resources, program characteristics like training requirements and exercise components, implementation support, evaluation methods, and gets sign off from relevant parties. The checklist helps ensure the program fits the facility's needs, budget, and abilities while providing an effective intervention to reduce falls risk factors for elderly residents.

Uploaded by

Marz Ziko
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Fall Prevention Program Checklist

https://public-library.safetyculture.io/products/fall-prevention-program-checklist

Fall Prevention Program Checklist


Needs Assessment, Target Audience & Available Resources
Are fall prevention activities feasible and will best serve the needs of the elderly?
Yes
No
N/A
Does the program fit our organization?
Yes
No
N/A
Does the program complement other programs already being offered?
Yes
No
N/A
Is the program appropriate for our target older adult population?
Yes
No
N/A
Are older adults in the nursing home interested in the program?
Yes
No
N/A
Is safe, reliable, and low-cost transportation to and from the program available?
Yes
No
N/A
Do we have personnel with the expertise to conduct the program or is there a system in place
to train program instructors?
Yes
No
N/A
Are the costs and resources needed within our budget?
Yes
No
N/A
Program Characteristics
Does the program require specially trained instructors?
Yes
No
N/A
Will the program provide education about fall prevention?
Yes
No
N/A
Does the program promote falls self-efficacy (confidence to prevent falls) among the
participants?
Yes
No
N/A
Are there opportunities for social interaction among the participants? (Such opportunities
contribute to program retention and sustainability.)
Yes
No
N/A
Does the program address modifiable risk factors (e.g., exercises to improve lower body
strength and balance)?
Yes
No
N/A
Can the program be tailored to meet the differing abilities of the participants?
Yes
No
N/A
Are exercises progressive (get more challenging over time)? This is a key component of an
effective fall prevention exercise program.)
Yes
No
N/A
Can your facility provide the amount of time needed to provide the recommended
intervention dose (e.g. for a total of 50 hours for a Tai Chi program)?
Yes
No
N/A
Does the program include strategies to reduce the possibility of activity related injuries?
Yes
No
N/A
Implementation
Are there program materials and training manuals available?
Yes
No
N/A
Can the program be implemented with fidelity in your setting?
Yes
No
N/A
Does the program offer strategies for linking participants and the program itself with
healthcare providers as needed?
Yes
No
N/A
Evaluation
Does the program include methods for maintaining and monitoring fidelity and program
quality over time?
Yes
No
N/A
Does the program include easy-to-administer pre- and post-functional tests, such as the
Timed Up and Go (TUG) test, to document improvements in participants’ functional
abilities?
Yes
No
N/A
Completion
Additional Recommendation

Nursing Home Supervisor Name & Signature


Sign
Aged Care Workers
Worker Name & Signature
Sign

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