Falls are a serious and frequent event in nursing homes, with approximately half of all residents experiencing one annually. These incidents carry a high risk of injury, affecting a resident’s independence and quality of life. A structured, calm, and immediate response is necessary to ensure the resident’s safety and mitigate potential harm.
Immediate Protocol Following a Fall
The discovery of a resident on the floor requires immediate, measured action. The first rule is to avoid moving the individual unless they are in immediate danger, such as in the path of a fire, as moving an injured person before assessment can worsen fractures or spinal cord damage. Staff should visually assess the resident for obvious signs of injury, including bleeding, deformity of limbs, or complaints of severe pain.
After the visual check, the responding staff member must immediately call for qualified help, typically a licensed nurse or physician, for a thorough clinical assessment. While waiting, the resident must be kept calm and comfortable, perhaps by covering them with a blanket to maintain body temperature. Staff should monitor and record the resident’s vital signs, such as blood pressure and heart rate, to establish a baseline for the medical team.
The priority remains stabilizing the situation and preventing further harm until a licensed professional determines if moving the resident is safe. A change in the resident’s level of consciousness or signs of significant bleeding necessitates an immediate call to emergency medical services. This phase focuses on securing the scene and providing immediate support.
Medical Evaluation and Post-Fall Care
Once the situation is stabilized, a licensed professional conducts a thorough physical examination to identify hidden injuries. This head-to-toe assessment focuses on areas prone to trauma, such as the head for potential internal bleeding, and the hips and limbs for fractures. A hip fracture is a common and serious consequence of falls in older adults, requiring prompt diagnosis and intervention.
A comprehensive post-fall assessment includes checking for factors that may have caused the fall, such as a drop in blood pressure. Orthostatic vital signs—measuring blood pressure and heart rate while lying down, sitting, and standing—can reveal postural hypotension, a common, remediable cause of syncope and falls. For residents taking blood thinners (anticoagulants), neurological monitoring must be maintained for up to 72 hours due to the elevated risk of intracranial hemorrhage, even from a minor head bump.
Diagnostic tools are utilized if injury is suspected or the fall remains unexplained. Imaging, such as X-rays for suspected fractures or a CT scan of the head for altered mental status, helps confirm or rule out internal injuries. Laboratory tests, including a complete blood count or electrolyte panel, are often ordered to identify metabolic derangements or infection that may have led to the fall. Medical professionals determine if the resident requires transfer to a hospital for specialized care or if injuries can be managed within the facility, aligning with the resident’s advance care plan.
Documentation and Investigation Requirements
The medical response is followed by an administrative procedure centered on documentation and investigation. Federal regulations require nursing homes to have systems for reporting and investigating all incidents, including falls, to ensure resident safety. The first step is creating a formal Incident Report, which must detail the circumstances of the event, including the exact time, location, and the activity the resident was engaged in before the fall.
This report must include any statements from the resident regarding how the fall occurred and the names of witnesses. Comprehensive documentation of the injuries sustained and all immediate interventions provided by the staff, including the medical evaluation, is necessary. This record is essential for legal, regulatory, and quality assurance purposes.
Facilities must notify the resident’s family or legally responsible party immediately following a significant change in condition, such as a fall resulting in injury or requiring medical intervention. For falls resulting in serious injury or death, federal guidelines mandate reporting to the state survey agency and Adult Protective Services within specific timeframes. An internal investigation must commence to uncover contributing factors, such as environmental hazards, equipment issues, or medication side effects, which informs the prevention strategy.
Reviewing and Adjusting the Care Plan
A fall signals a change in the resident’s risk profile and necessitates an immediate review of their individualized care plan. An interdisciplinary team, including nursing staff, physical therapists, and the physician, must convene to evaluate the incident and determine the root cause. The goal is to identify specific, modifiable factors that contributed to the fall to prevent a recurrence.
Medication review is a priority, especially for drugs known to affect balance, such as sedatives, antipsychotics, or certain blood pressure medications, which may require dosage adjustment. Specialized fall prevention interventions are integrated into the plan, often within 72 hours of the event. These adjustments may include increased supervision during high-risk periods, such as toileting, or implementing technology like bed alarms or pressure mats.
Environmental modifications are also considered, such as ensuring better lighting, removing clutter from the resident’s path, or providing a low-height bed. The revised care plan must be specific to the individual, addressing the identified cause. The effectiveness of the new interventions should be monitored closely by the care team. This continuous cycle of assessment, intervention, and evaluation is crucial for enhancing resident safety.