A fall is described as involuntarily coming to rest on a lower surface, or “an unintentional loss of balance, causing one to make unexpected contact with the ground or floor”.(Texas A&M University, October 2013).
Whether a resident has been observed stumbling and has been assisted to the floor or the fall is an un-witnessed event that leads to an injury, all falls have to be reported and investigated. This will determine what interventions must be put in place to keep the resident safe. With un-witnessed falls, we should play it safe by doing neurological checks on the resident.
All other incidents and accidents, including bruising and skin tears must be reported, investigated and interventions put in place to prevent any re-occurrence.
Falls are unfortunately a frequent occurrence in Long Term Care (LTC) facilities. Falls have an extremely adverse reaction both physically and psychologically on the elderly. Many residents die as a result of a fall and those who survive may sustain injuries that can cause functional decline, decreased mobility or permanent disability. Falls can also result in pain and discomfort. Psychological impacts can include loss of confidence, becoming socially withdrawn and feel less independent. All or any of the above factors can reduce the resident’s quality of life.
LTC facilities should have in place the following procedures:
Fall Policy: There should be a process in place for investigation and treatment.
Fall Prevention Program: Many facilities have discreet programs in place to identify residents at risk (a sign of a falling leaf that would indicate to staff a resident at risk of falling, safety signs, colored bracelets) etc.
A Fall Team that should convene monthly to discuss current falls, the reasons residents fell, interventions and measure outcomes for success or failure. A fall log should be maintained listing fall occurrences, interventions and outcomes including date and time of fall and of notification of physician and family. All staff should follow the facility policy for reporting to the proper state agency.
Everyone on staff should understand why falls are a risk factor and should know the residents who are frequently fall or those at a high risk for falls. The key is to be always watching the residents, to monitor what they are doing and interact with them as often as possible. Awareness of the legal liability associated with falls and resultant injuries should be a high priority for caregivers.
Caregivers should identify prevention techniques and therefore we should always be on the look out for any changes in the resident. The nurses aid is the eyes, ears and hands of the care team and detecting change is one of the most important things she/he can do. Knowing the resident’s ability to move around, transfer, perform Activity of Daily Living (ADL), and identifying a decline can predict the risk of falling.
Based on frequent assessments, the direct care staff should know if the residents can recognize their safety needs, can remember and understand those needs. Residents should be reminded frequently to call for help and they should be reassured that the nursing staff are there to help.
When a fall occurs it must be investigated immediately and completely.
Care and safety of the resident is always first. Some of the factors that need to be considered are:
Describe the fall scene, what was the resident attempting to do?
Was the call light on and unanswered?
Was it within reach of the resident?.
When was the resident last seen, toileted or medicated for pain, etc.
Were adaptive devices involved?.
Recreating the scene with witnesses and team members may be beneficial. Monitoring that all previous interventions are in place is necessary.
Identify and review all intrinsic and extrinsic factors.
Muscle weakness, gait impairment and poor balance are the most common causes for falls. Age related risks including poor eyesight, disease progression, memory loss and poor judgement are all causal factors. Hypoglycemia, hypo-tension and medications that affect the Central Nervous System, such as sedatives and anti- anxiety medications also need to be checked. The resident should be monitored for 72 hours following any changes in the dosage of these drugs.
Environmental hazards, such as wet floors, poor lighting, rugs or carpets that are not properly secured and clutter can all contribute to falls and injuries. Equipment, including walkers, wheelchairs and lifts all need to examined to ensure they are properly maintained. Residents who use powered wheelchairs should be assessed frequently by the physical therapy to insure ability and safety. The maintenance department should examine all equipment routinely to determine safety and repair needs.
Interventions must be related to the cause of the fall. The care team should discuss the best one to keep the resident safe and avoid re-occurrence. For residents with cognitive problems, behavior strategies to help avoid hazardous situations may be necessary. All interventions must be included in the care plan and staff must be aware of them. Most important, the intervention must be used, for it to work.
Exercise programs to improve balance, physical functioning and ambulation ability may be provided by Physical Therapy or Restorative Nursing.
