Skilled Nursing
Articles
Top Ways to Mitigate Fall Risks
June 16, 2024
One out of four older adults will fall each year in the United States. While falls are common, especially among Americans aged 65 and older, many are preventable and do not have to be an inevitable part of aging. And facilities can play a crucial role in lowering the incidence.
5 Ways to Prevent Fall Risks in Long-Term Care
Post-acute settings can be particularly challenging for older adults. With proper interventions, however, facilities can see a reduction in falls.
1. Night noise. Residents can be woken during the night due to frequent noise or bright lights, and may fall either trying to get up to stop the noise or turn down the lights. The risk of falling can continue into the next day, when they are groggy and unrested. Facilities can respond by turning down bright lights at night, not pushing noisy carts around in resident areas, and encouraging staff not to gather at the nurses stations during the night shift but move their conversations to a utility or break room instead.
2. Low blood pressure. In one study, the most common reason residents fall at the bedside is orthostatic hypotension. To address this issue, blood pressures should be checked on a routine basis for those with potential orthostatic hypotension. Medications and/ or increased fluids can be initiated where indicated. For others, teaching residents to sit on the edge of the bed and count to 10 before standing can be a successful intervention.
3. Balance issues. The majority of those who fall midway to their door have balance issues. And among those who make it to their doorway and then fall, most have endurance issues. Physical therapy can be helpful in alert residents as well as cognitively impaired residents.
4. Low beds. Without the right height bed, residents may fall because they can’t stand up straight when getting out of the bed. One way to combat this problem is for the facility to ensure all residents have right-sized height beds. This may involve the assistance of therapy to measure all residents sitting on the side of the bed to make sure they are at a 90-degree angle bend at the knee with their feet flat on floor, then mark the wall behind the bed with colored tape to show the height of the headboard top and bottom. This assures that staff who raise and lower the bed place it at the right height between the colored tape.
5. Mats and gripper socks. It’s not uncommon for residents to trip over a mat or slide in gripper socks. If your facility still uses these products, consider discontinuing their use. The bottom line is that, if someone wants to get up, they’re going to, so it’s crucial to find ways to make it safe for them when they do.
10 Steps to Take After a Fall
Despite all precautions, a resident may fall. There are steps a facility can take to mitigate future falls going forward.
1. Ask the resident if they are okay and complete a head-to-toe assessment. Apply first aid if indicated and/or call 911/physician if an ER visit is warranted.
2. Ask the resident what they were trying to do and what were they doing just prior to the fall.
3. Ask the resident what was different this time.
4. Complete a “CSI” (“crime scene investigation”): Did the resident fall near a bed, toilet, or chair? How far away was it? Are they on their back, front, or left or right side? What is the position of their arms and legs?
5. What was the surrounding area like? Noisy? Busy? Cluttered? Is there poor lighting or visibility? What is the position of furniture and equipment? Is the bed height correct?
6. What was the floor like? Wet? Uneven? Shiny? Carpeted or tiled?
7. What was the resident wearing? Shoes? Socks? Slippers? Poorly fitting clothing?
8. Was the resident using an assistive device, like a walker, cane, or wheelchair?
9. Did the resident use hearing aids or glasses, and were they on?
10. Who was in the area when the resident fell?
If the resident suffered a serious or potentially serious injury, or if the incident has happened repeatedly, take the information and hold a short, ad-hoc QAPI meeting. Gather any staff on that hall/unit that can attend and include leadership if they are in the facility. If the fall occurred on the overnight shift, the nurse and one aide may be all in attendance. In the meeting, determine the root cause from the data collected and come up with an intervention
specific to what happened – not just generic. Add it to the care plan. If equipment such as a lift was involved, or a staff person not following the care plan, all residents potentially affected would need to be identified.
This process and tool have prevented many harm-level deficiencies when completed immediately after an incident that could have possibly been prevented or one that is serious in nature. The reality is we cannot prevent everyone from falling, but we can show we did our best to reduce the likelihood.