Falls Prevention and QI Reporting in Aged Care

Falls are the most common cause of injury-related hospitalisation among older Australians in residential aged care. For providers, falls are not just a clinical concern — they are a regulatory one. Falls and major injury from falls is one of the 14 mandatory quality indicators under the National Aged Care Mandatory Quality Indicator Program (NAQIMQP), and performance on this indicator feeds directly into the star ratings system. Effective falls prevention saves lives, reduces hospitalisations, improves quality of care, and protects your organisation's public rating. Yet many providers still treat falls as inevitable rather than preventable. The evidence is clear: a systematic, multifactorial approach to falls prevention — combining risk assessment, environmental modification, medication review, and targeted exercise — significantly reduces both the rate of falls and the severity of injuries when falls do occur.

The NAQIMQP requires residential aged care providers to collect and submit data on two falls-related quality indicators each quarter: the rate of falls per 1,000 occupied bed days and the rate of falls resulting in major injury per 1,000 occupied bed days. Major injury is defined as a fracture, or a head injury or other trauma that requires transfer to hospital or treatment by a medical practitioner beyond first aid.

The rate calculation is straightforward: divide the total number of falls (or falls with major injury) during the quarter by the total number of occupied bed days, then multiply by 1,000. For example, a 60-bed facility operating at 95% occupancy over a 91-day quarter has approximately 5,187 occupied bed days. If 45 falls occurred in that period, the rate is 8.7 falls per 1,000 bed days.

These rates are benchmarked against national averages published by the Department of Health and Aged Care. Your performance relative to the national benchmark — not just your raw rate — determines your Quality Measures sub-rating in the star ratings system. Providers who consistently perform above the national average will see their star rating penalised, while those below the average gain a competitive advantage. Accurate data collection is essential. Every fall must be recorded, regardless of whether injury occurred, and the definition of a fall must be applied consistently by all staff.

Falls prevention begins with identifying who is at risk and why. A validated falls risk assessment should be completed for every resident on admission, after any fall, after a significant change in condition, and at regular intervals (at minimum quarterly). The assessment should capture both intrinsic and extrinsic risk factors, because falls are almost always multifactorial.

Intrinsic risk factors include: impaired mobility or gait instability, cognitive impairment (dementia, delirium), history of previous falls, visual or hearing impairment, continence issues (rushing to the bathroom is a common fall trigger), postural hypotension, chronic pain, and lower limb weakness.

Medication-related risk deserves particular attention. Sedatives, benzodiazepines, antipsychotics, opioids, antihypertensives, and diuretics all independently increase falls risk. Polypharmacy — typically defined as five or more regular medications — compounds the risk. Any resident on psychotropic medication should be flagged for enhanced falls monitoring and regular medication review.

Extrinsic risk factors include: inadequate lighting, wet or uneven flooring, poorly fitting footwear, cluttered walkways, inappropriate bed or chair height, lack of grab rails, and restraint use (which paradoxically increases fall severity when residents attempt to free themselves).

Quality Standard 3 (Care and Services) and Standard 5 (Clinical Care) both require that assessments are comprehensive, evidence-based, and translated into individualised care plans. A falls risk assessment that sits in the file without driving a targeted prevention plan does not meet the standard.

Effective falls prevention is multifactorial. No single intervention is sufficient on its own, but the evidence strongly supports the following strategies when implemented together.

Strength and balance exercise programs. Targeted exercise — particularly progressive resistance training and balance exercises — is the single most effective falls prevention intervention. Programs should be tailored to each resident's functional capacity and delivered by physiotherapists or trained exercise professionals. Group programs improve adherence and have additional social benefits.

Medication review. A pharmacist-led medication review should be conducted on admission, after any fall, and at least annually. The specific focus should be on reducing or withdrawing sedatives, benzodiazepines, and psychotropics where clinically appropriate. Research consistently shows that medication rationalisation reduces falls rates by 30-40% in residential aged care.

Environmental modification. Conduct regular environmental audits of resident rooms, bathrooms, corridors, and communal areas. Ensure adequate lighting (particularly at night — sensor-activated night lights are effective), remove tripping hazards, install grab rails in bathrooms and along corridors, ensure beds and chairs are at the correct height, and provide non-slip flooring in wet areas.

Assistive devices and footwear. Ensure residents have access to appropriate mobility aids (walking frames, wheelchairs) that are correctly fitted and regularly maintained. Hip protectors reduce fracture risk for residents at high risk of falling. Footwear should be well-fitting with non-slip soles — loose slippers are a significant and avoidable risk factor.

Vision and hearing checks. Arrange regular optometry reviews and ensure prescription glasses are clean, current, and available. Untreated cataracts, glaucoma, and macular degeneration all increase falls risk.

Staff education. All care staff should receive training in falls risk factors, prevention strategies, correct use of mobility aids, safe manual handling, and post-fall response. Training should be practical, scenario-based, and refreshed at least annually.

When a fall occurs, the immediate response determines both the clinical outcome and the compliance position. Every fall — regardless of apparent severity — requires immediate clinical assessment. This means a registered nurse assessment of vital signs, neurological observations (particularly for head strikes), pain assessment, and physical examination for injury. Do not move the resident until a clinical assessment has determined it is safe to do so.

A structured post-fall investigation should follow within 24 hours. The investigation should identify: the circumstances of the fall (time, location, activity, witnesses), contributing factors (was the resident reaching for something? Were they unattended during a high-risk transfer? Had medication been recently changed?), whether the existing care plan addressed the identified risk factors, and what changes are needed to prevent recurrence. The resident's care plan must be updated to reflect the findings.

When does a fall become a SIRS incident? A fall that causes serious harm — specifically, injury that requires medical or psychological treatment — may trigger a SIRS notification obligation. If the fall results in a fracture, a head injury requiring medical treatment, or any other injury requiring transfer to hospital or treatment beyond first aid, it is likely a Priority 1 reportable incident. Priority 1 incidents must be notified to the ACQSC within 24 hours. The 24-hour clock starts from the moment any staff member becomes aware that the injury meets the threshold.

Open disclosure is required when a fall results in serious harm. The resident and their family or representative must be informed of what happened, what is being done to treat the injury, what investigation is underway, and what steps are being taken to prevent recurrence.

Statura Care provides an integrated approach to falls prevention, QI reporting, and incident management — eliminating the silos that cause data to fall through the cracks.

The Clinical Care module includes a Falls Risk Assessment as one of 9 built-in clinical assessment tools. Assessments can be completed on admission and at configurable intervals, with automated alerts when reassessment is due or when risk levels change. Assessment scores feed directly into care plan recommendations, ensuring that identified risks drive targeted interventions.

The Quality Indicators module tracks your falls rate and major injury rate against national benchmarks in real time — not just at quarterly submission time. QI dashboards show trend data so you can identify whether your prevention strategies are working, spot seasonal patterns, and intervene before your rate drifts above the benchmark. When it is time to submit, your data is already validated and ready.

The SIRS module automatically captures falls that result in serious harm and triggers the appropriate priority classification and deadline countdown. If a fall recorded in the clinical module meets the threshold for a Priority 1 incident, Statura creates the SIRS notification workflow immediately — ensuring the 24-hour deadline is never missed because of a manual handoff failure between clinical and compliance teams.

Clinical alerts notify nursing staff when a resident's falls risk profile changes — for example, after a new psychotropic medication is prescribed or after a cognitive assessment indicates decline. These alerts close the loop between assessment, prevention, and monitoring, giving your clinical team the information they need to act before the next fall occurs.