M1910 Oasis

Just trying to get an idea of thoughts on this question about the multifactorial falls risk assessment. Seems to me that if a patient can't do a TUG test (bedbound, or needs physical assist to walk) that the answer to "have you done a multifactorial risk assessment?" is NO.

Thoughts?

You have to use a validated tool - as of now, there is no validated multifactorial falls risk assessment tool. So for now, the answer is no.

The answer to that question M1910 is always "yes". My patients are always at risk for falls and have always been assessed for that.

Your nurses assesment IS the multifactorial fall risk assessment!

Fact #1. Meds that can cause light-headedness or other s/e's causing risk for falling

#2. Confusion....Mental deficits...

#3. Physical Therapy referral

#4. Use of an assistive device

#5. Joint pain, stiffnes

Your nurses assesment IS the multifactorial fall risk assessment!

Fact #1. Meds that can cause light-headedness or other s/e's causing risk for falling

#2. Confusion....Mental deficits...

#3. Physical Therapy referral

#4. Use of an assistive device

#5. Joint pain, stiffnes

No, CMS specifically states the assessment is not considered the multifactorial fall risk tool. In order to check yes - the clinician must use a tool that has been scientifically tested and validated as effective in identifying a specified condition or risk in population being evaluated (community-dwelling elderly) and include a standard response scale.

If you are not using a validated tool then you must check - NO.

No, CMS specifically states the assessment is not considered the multifactorial fall risk tool. In order to check yes - the clinician must use a tool that has been scientifically tested and validated as effective in identifying a specified condition or risk in population being evaluated (community-dwelling elderly) and include a standard response scale.

If you are not using a validated tool then you must check - NO.

This is what I thought as well. But what if your patient is not a candidate for the TUG test? ie need assist to walk or are bed bound? The answer will always be technically "NO" but they are still at risk for falls. Our agency will document that and still do a PT referral, but answer "NO" because a multi factorial assessment was not done due to patient not qualifying for the test..

This is what I thought as well. But what if your patient is not a candidate for the TUG test? ie need assist to walk or are bed bound? The answer will always be technically "NO" but they are still at risk for falls. Our agency will document that and still do a PT referral, but answer "NO" because a multi factorial assessment was not done due to patient not qualifying for the test..

That's correct, if you can't perform a multi factorial assessment then the answer would have to be "NO". You should know that the TUG test alone would not qualify as a multi factorial assessment either.

we have been looking into this as well.

according to [color=#606420]http://www.health.vic.gov.au/agedcare/maintaining/falls/downloads/ph_frat.pdf the frat (falls risk assessment tool) is considered a validated tool produced by the national ageing research institute (funded by the department of health and human services) and is recommended for general use. this seems to fit the criteria described in the intent of m1910. the tool itself is very comparable to the missouri alliance for home care tool, but is slightly more comprehensive and provides a more detailed standard response scale. any thoughts?

I brought this up in a recent OASIS Answers seminar and was told that the tool must be validated for use with community-dwelling seniors. I didn't see anything in the FRAT to indicate that it has been validated with that specific population. Anyone have any more info?

The TUG is considered to be a validated tool, but not a multifactoral tool. If you combine the TUG with a standard fall-risk assessment, then you have completed a validated, multifactoral fall risk assessment. This is the answer that I received from the OASIS Answers people who publish the quarterly Q&As.

I believe you are correct. I read the intent for M1910 closer and it specifies that we must use a "tool that has been validated as effective in identitying falls risk in community-dwelling elders...". The FRAT has been validated for general use, so does that include community-dwelling elders? I guess we are still looking for the magic bullet--one fall risk assessment tool that is both validated and multifactorial. I've heard there is a push to get the Missouri Alliance for Home Care validated.....

TUG or Tinetti in combination with your assessment (meds, environmental issues, etc), will work.

The answer to that question M1910 is always "yes". My patients are always at risk for falls and have always been assessed for that.

The QA RN at my agency told me just this week that if the pt can NOT complete the TUG, for whatever reason, you answer 'no' to whether or not a fall risk assessment was completed. They are still at risk for falls, however, and it should be on our POC regardless of completing a TUG