Tools to Reduce Falls in Nursing Homes
Every community struggles to manage fall risk. Falls are a result of a number of causes, some of which are physical and some environmental. We can't prevent every fall, but communities have shown that there are ways to reduce falls.
This article focuses on some of the top practices that are helping communities reduce falls. This is a collection of practical steps and tools you can start using right away that apply to the continuum of care, including assisted living, long term care, skilled nursing, and hospital settings.
The key ingredients to any fall prevention strategy are a holistic look at both the resident and the environment, a customized care plan to target resident specific risk factors, and a continual process of improvement. That is exactly what we'll cover. Let’s get into it.
This article focuses on some of the top practices that are helping communities reduce falls. This is a collection of practical steps and tools you can start using right away that apply to the continuum of care, including assisted living, long term care, skilled nursing, and hospital settings.
The key ingredients to any fall prevention strategy are a holistic look at both the resident and the environment, a customized care plan to target resident specific risk factors, and a continual process of improvement. That is exactly what we'll cover. Let’s get into it.
Falls Team
If you don’t have one yet, you need one. This is a small multidisciplinary group of three to five members, affectionately called the "falls team". This is a group specifically tasked with reducing falls in your community. They are your champions for change. The group should initially meet to create (or update) your fall assessment and fall mitigation tools. These will be the core of your standard operating procedures around falls. After the initial setup, the group meets monthly to review fall reports and adjust the fall prevention strategy as needed.
Fall Risk Assessment
The first thing the team should create is a fall risk assessment tool, used by staff upon admission of a new resident. This tool allows staff to quickly and accurately gauge the resident’s potential fall risk and craft a care plan to mitigate this risk. Core components of the fall risk assessment tool should include the following.
This assessment should be performed on admission, and done again on a routine basis (ex. every 3 months) or after a fall or a change in medication. Change in medication can cause a significant increase in fall risk.
There are a number of fall risk assessment tools that you can start from. Here are a few. You'll probably want to start with one of these and add additional information you want to capture in your community to meet your specific needs and better inform your care plan.
- Interview the family to understand past fall risk and areas of concern
- A full review of the resident's medical history, including medication, history of falls, and use of assistive devices such as walkers
- A full review of medications the resident is on and any side effects
- Completion of the Timed Up and Go Test to judge fall risk. This test allows you empirically rate the fall risk of the resident
This assessment should be performed on admission, and done again on a routine basis (ex. every 3 months) or after a fall or a change in medication. Change in medication can cause a significant increase in fall risk.
There are a number of fall risk assessment tools that you can start from. Here are a few. You'll probably want to start with one of these and add additional information you want to capture in your community to meet your specific needs and better inform your care plan.
Customize the Care Plan
With the assessment complete we turn to the care plan. You know care planning, so we'll spare some of the detail here, but what's most important is to customize the care plan to address specific risks identified in the assessment. Here are some examples.
If the resident is a high fall risk because of psychiatric medications, is it possible to change or alter the medication, dosage or schedule to reduce fall risk? If the resident has incontinence issues, can staff alter the evening routine to reduce these events? For example, no water after 6PM, or make sure the resident toilets right before bed. If the resident uses a hearing aid or glasses, how do we make sure these are in reach at all times so they don’t need to get up to get them?
And more basic checks like, making sure mobility devices are in good condition, or using colored socks or room tags so staff know a resident is high fall risk.
Does the resident use the call bell to signal they need help getting up? Some resident's with dementia don't know to use the call bell, and need assistive devices like bed alarm pads or upBed to notify staff before they are up.
Environmental Checklist
Other fall risks can be contributed to the resident’s environment. Common fall risk factors include lightening (especially at night), clean and dry floors, toilet seat height, bed height, foot wear, and more.
Some mitigation for the environment include floor mats, lowering beds, and adding lighting. Is the bed facing the bathroom, so if the resident gets up they have a clear path to the bathroom?
Some mitigation for the environment include floor mats, lowering beds, and adding lighting. Is the bed facing the bathroom, so if the resident gets up they have a clear path to the bathroom?
Post Fall Assessment
Even if the above is perfect, falls can still occur. When they do happen, it's important to use these as learning opportunities.
Quickly huddle the team together when falls occur to collect as much information as possible and perform a root cause analysis. This information is commonly captured in a fall reporting spreadsheet each month. This includes who fell, the time and location, description of fall, was there an injury, and additional information like medication, last toileting time, and whatever else will help your team understand the fall and context around it.
Fall reports should be reviewed immediately by the falls team, and then again each month. Monthly and yearly meetings are intended to identify patterns in falls. Use these patterns to adjust the risk assessment and care plan.
Quickly huddle the team together when falls occur to collect as much information as possible and perform a root cause analysis. This information is commonly captured in a fall reporting spreadsheet each month. This includes who fell, the time and location, description of fall, was there an injury, and additional information like medication, last toileting time, and whatever else will help your team understand the fall and context around it.
Fall reports should be reviewed immediately by the falls team, and then again each month. Monthly and yearly meetings are intended to identify patterns in falls. Use these patterns to adjust the risk assessment and care plan.
Prevention Through Exercise
Don’t forget physical therapy and strengthening exercises. Although this is resident specific, in general the less mobile a resident becomes the greater risk they are of falling. It pays to move around!
Continual Improvement
Reducing falls is a continual process. By creating a standard assessment tools, customizing care plans to mitigate fall risk, and improving the resident's environment falls can and will be reduced.
Do you have advice or want to add to this content? Contact us using our Contact page above.
Do you have advice or want to add to this content? Contact us using our Contact page above.