Falls Management 

Effective Date: [Original NPP Date] 
Revised Date: [Current Date] 

Clinical Goal: 

Falls are a leading cause of death and injury among the elderly in nursing homes. Close to 50% of residents fall annually, and 10% of these falls result in significant injury, such as fractures. Falls often signal the existence of other health-related issues such as functional decline, delirium, adverse drug reactions, dehydration, and infections. External factors such as the use of appliances, restraints, and environmental conditions can also play a role in causing falls. Regardless of causation or risk factors, professionals caring for the elderly must ensure interventions are in place to prevent falls and avoid unnecessary injuries. 

Standard: 

Our facility is committed to promoting the highest level of functioning and quality of life for residents by providing an environment that remains as free of accident hazards as possible. Each resident is assisted in attaining or maintaining their highest practicable level of function by providing adequate supervision, assistive devices, and functional programs to prevent accidents. All fall events are identified and investigated to determine their cause and to implement preventive interventions. 

Policy: 

It is the policy of this facility to assess each resident for fall risk factors and develop a care plan based upon identified factors. Staff are educated and trained to implement fall prevention plans and clinically manage fall events when they occur. Residents who fall have these events analyzed for clues to further evolve an effective prevention program. Measures are taken to ensure the environment is as safe and hazard-free as possible. Human behavior, being unpredictable, can contribute to falls. Chair and bed alarms should be used sparingly as they have been shown to be unreliable in fall prevention. The most reliable method in fall prevention is to anticipate and proactively address conditions that might cause the resident to stand, climb, lean, or reach without seeking assistance. 

Procedures: 

Resident Assessment: 

• At the time of admission, each resident is assessed using the Falls Risk Assessment to determine their risk for sustaining a fall. 

• Residents at high risk for falls must have a fall prevention plan immediately developed and implemented. 

• Residents will be reassessed for fall risks under the following conditions: 

• A new fall event 

• A readmission 

• A clinical condition change (i.e., significant functional and/or mental decline) 

• The emergence of a new fall risk factor (i.e., cardiovascular, neuromuscular, orthopedic, perceptual, cognitive, adaptive devices, environmental/situational hazards, etc.) 

• Outcomes of care plan interventions will be documented in the resident’s medical record. 

• Neurological checks will be documented on the Neurological Assessment Flow sheet for 72 hours if: 

• The resident states they hit their head 

• There is physical evidence of hitting the head 

• The fall was unwitnessed and the resident is an unreliable historian 

• When a resident sustains a fall, a Registered Nurse performs an injury assessment before moving the resident. Results are documented by this nurse on the Post Fall Nurse’s Notes and the 24-Hour Nursing Report Form. Follow-up monitoring and documentation will be conducted for a minimum of every shift for 72 hours, recorded on the 72-Hour Post Incident Documentation Form. 

• The attending physician and responsible party are notified of the fall and the resident’s status. 

• A resident fall is considered an incident, and details will be documented on the facility’s designated form for recording such events. 

• When a resident falls, an investigation will be conducted to determine probable causative factors such as environmental factors, underlying medical conditions, resident behavior, and/or the use of assistive devices. The investigation and appropriate interventions will be initiated at the time of the fall and reviewed by the Interdisciplinary Team during the next morning meeting. 

• Additional follow-up measures will be conducted based on the nature of any injury sustained and in keeping with accepted standards of practice. 

Falls Management Committee: 

• The Falls Management Committee meets monthly to review and analyze trends in resident falls and to implement and evaluate the effectiveness of action plans designed to improve the quality of resident care and life. The committee also identifies residents experiencing frequent fall events. These residents may be referred to the “Falling Leaf” program, designed to visually identify residents so all staff are aware that these residents require close supervision in all activities. A symbol (i.e., leaf) may be placed within the resident’s room, bathroom, dining chair, wheelchair, and walker for ease of identification. Residents remain in this program until the frequency of falls diminishes. 

Care Planning: 

• Residents identified as at risk for falls upon admission/readmission or as identified on the MDS or through clinical judgment will have an individualized care plan developed that includes measurable objectives and timeframes. Care plan interventions will be developed based on assessed risk factors. The care plan will be developed at the time the risk is identified with ongoing evaluation and revisions documented. 

• Residents who sustain a fall will have a care plan developed or the existing care plan revised at the time the incident occurs. Interventions will address elements determined by investigation as probable causal factors contributing to the fall. The updated fall prevention plan will be implemented immediately and reviewed by the Interdisciplinary Team during the next morning meeting. The Fall Management Committee will review the quality of prevention programming to ensure all fall strategies are thoughtfully balanced with each resident’s quality of life. 

Fall Prevention Outcomes/Documentation: 

• Documentation of implementation will be in accordance with acceptable standards of clinical record keeping as outlined in Federal and State Regulations and Industry Standards of Practice. 

References: 

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities. [Link to current CMS SOM] 

• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]