J1800: Any Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent

J1800: Any Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent

Item Rationale

Health-related Quality of Life

• Falls are a leading cause of morbidity and mortality among nursing home residents.

• Falls result in serious injury, especially hip fractures.

• Fear of falling can limit an individual’s activity and negatively impact quality of life.

Planning for Care

• Identification of residents who are at high risk of falling is a top priority for care planning. A previous fall is the most important predictor of risk for future falls.

• Falls may be an indicator of functional decline and development of other serious conditions such as delirium, adverse drug reactions, dehydration, and infections.

• External risk factors include medication side effects, use of appliances and restraints, and environmental conditions.

• A fall should stimulate evaluation of the resident’s need for rehabilitation, ambulation aids, modification of the physical environment, or additional monitoring (e.g., toileting, to avoid incontinence).

Steps for Assessment

1. If this is the first assessment/entry or reentry (A0310E = 1), review the medical record for the time period from the admission date to the ARD.

2. If this is not the first assessment/entry or reentry (A0310E = 0), the review period is from the day after the ARD of the last MDS assessment to the ARD of the current assessment.

3. Review all available sources for any fall since the last assessment, no matter whether it occurred while out in the community, in an acute hospital, or in the nursing home. Include medical records generated in any health care setting since last assessment.

4. Review nursing home incident reports, fall logs and the medical record (physician, nursing, therapy, and nursing assistant notes).

5. Ask the resident and family about falls during the look-back period. Resident and family reports of falls should be captured here whether or not these incidents are documented in the medical record.

Coding Instructions

• Code 0, no: if the resident has not had any fall since the last assessment. Skip to Swallowing Disorder item (K0100) if the assessment being completed is an OBRA assessment. If the assessment being completed is a Scheduled PPS assessment, skip to Prior Surgery item (J2000).

• Code 1, yes: if the resident has fallen since the last assessment. Continue to Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS) item (J1900), whichever is more recent.

Example

1. An incident report describes an event in which Resident S was walking down the hall and appeared to slip on a wet spot on the floor. They lost their balance and bumped into the wall, but were able to grab onto the hand rail and steady themself.

Coding: J1800 would be coded 1, yes.

Rationale: An intercepted fall is considered a fall.

DEFINITION

PRIOR ASSESSMENT

Most recent MDS assessment that reported on falls.