Falls - Everyones Responsibility

As seen in Consultant Connection August 2012 Issue
by Kathie Klepcyk, RN

A simple Google search produces more than these results on 'nursing home related falls':
  • Improper Transfer Leads To Fall & Ultimately Death Of Rehab Patient
  • How Many Falls Is Enough To Impose Responsibility On Nursing Home?
  • 2 Residents Fall From Wheelchairs With 2 Days At Nursing Home
  • Nursing Homes Post-Fall Care Of Injured Patient Criticized By State Investigators
  • Nursing Home Sued After Resident Fractures Both

Hips In Separate Falls

The public, our consumers, are well aware of issues relating to nursing home duty to protect patients from falls and the nursing homes liability for falls. How well equipped is your staff to handle the task?

Studies find that one in five newly admitted nursing home patients has a fall within one month, and that higher levels of staffing with certified nursing assistants reduces the risk of patient falls. This is likely because certifi ed nursing assistants provide most of the hands-on patient care during high fall-risk activities such as dressing, using the bathroom, and moving around. Identifying and managing fall risks among these residents is a challenge because these people are in a new place and are unfamiliar to staff. It can be noted that some newly admitted nursing home residents are there for rehabilitation with the eventual goal of sending them home. Falls can delay or permanently prevent the patient from returning to the community, and identifying risks of falling is essential for implementing fall-prevention strategies and facilitating successful discharge back to the community.

The statistics are alarming:
  • The largest single cause, at 36 percent, of potentially preventable hospital emergency room visits made by nursing home residents is injury due to a fall.
  • The death, sometimes wrongful death, of approximately 1,800 nursing home residents each year can be attributed to fall-related injuries.
  • A typical, 100-bed nursing home reports 100 to 200 falls per year &mdash more than one per patient &mdash and many falls aren't reported.
  • Adults 65 and older are four times more likely to die of fall-related injuries if they live in a nursing home than if they do not.
  • Up to 75 percent of nursing home residents fall each year — more than double the rate for seniors who don't live in nursing homes &mdash and the average is over 2.5 falls per person per year.
  • Over a third of fall-related injuries happen to residents who can't walk.
  • Although a relatively small number (2 to 6 percent) of falls result in fractures, 10 to 20 percent of nursing home falls do cause serious injuries, which can lead to loss of function and disability; the resulting fear of falling can also lead to further loss of function, social isolation, and depression.
It's true that nursing home residents are on average older and in poorer health than seniors who live in the community, so therefore may be more prone to fall. However, a well-run nursing home should be able to prevent most falls. Staff should be attentive to patients at risk of falling and ensure that they receive proper foot care and shoes and have (and know how to use) appropriate walking aids. They should eliminate environmental hazards, such as poor lighting, slippery fl oors, and incorrect bed height, which cause nearly 30 percent of nursing home falls. All health care professionals in the nursing home setting must work together to help encourage nursing home safety. Nursing homes are required to conduct a fall-risk assessment for every resident to determine who may be at risk for falls. The fall-risk assessment is particular to preventing falls because it sets forth what accommodations should be in place for each resident.

Staff should always be on the lookout for residents who may require assistance getting about. If residents have a history of falls, the facility should consider using alarms on chairs or beds to notify the staff when the person attempts to walk on their own.

Some of the more common causes of nursing home falls include:
  • Hazards in the nursing home – wet floors, poor lighting, improper bed heights, improperly maintained wheelchairs, equipment left out of place
  • Medications – Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs (psychoactive drugs)
  • Improperly fitting shoes or incorrect walking aids
  • Frequent use of restraints
  • Facilities failing to provide assistance or provide specialized bathing equipment including chairs, stands and grips
  • Transfer into and out of bed
  • Failing to engage locks on wheelchairs
  • Poorly maintained stairways and walkways
Centers for Medicare & Medicaid the Federal Regulation related to falls can be found at 483.25 F-tag 323: Accident, plus potential related F-Tags for additional investigation include:
  • F- Restraints
  • F-223 Abuse
  • F-272 Comprehensive Assessments
  • F-279 Comprehensive Care Plans
  • F-280 Comprehensive Care Plan Revision
  • F-281 Professional Standards
  • F-353 Suffi cient Staff
  • F-520 Quality Assessment & Assurance
Falls will occur despite your best efforts. ICP Nursing Services has tools to help with assessing your current programs and protocols, call Mary Burkart, RN Nurse Coordinator for assistance or forms and contact your ICP Nurse Consultant at any time.

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