Low beds, falls and incident reports...

[night owl]

OK, I've got a question. If a resident is found on the matt on the floor by his bed, assuming the bed is in the lowest position, do you all make out an incident report? We've been told two stories by two different people and that is as long as he/she is on the matt and the bed is in the lowest position that no report is necessary. Then we've been told that whenever a resident is found on the floor it is considered a fall, hence a report. Ok ladies and gents, which one is it? I'm thinking incident report anyway just to CYA.

[CapeCodMermaid, RN]

Side rails are only considered restraints if they prevent the resident from getting up out of bed. We have all newer electric beds with 1/4 side rails. They are NOT restraints since they don't keep anyone in the bed ...only act as positioning aids.

PS Our new policy is to put a personal alarm on ALL new residents for the first 72 hours....they better not ever do that to me!!

[jaimemds]

Being an MDS coordinator for years, I have to say that ANY time a resident rolls oob, even if to a blue matt or blue matt to floor, is a fall. Any time a resident stumbles or trips and needs staff assistance to prevent them from falling to the floor, it is considered a fall. It is important to document these incidents as falls because it triggers certain risk areas. This pt could be receiving a pyschotropic medication that has resulted in AE's. The stumble/unsteady gait could also be from psych meds or deydration, etc. For the facility w/a no restraint policy, SR's used to enhance/enable a persons independence ARE NOT RESTRAINTS! I hope no one has fall and received an injury in that facility d/t not being able to get oob safely because of no sr's, state will have a field day with it. It could lead to an actual harm citation. SR's are an effective fall prevention if used correctly.

[donmomofnine]

In our facility, if a resident frequently rolls out of bed and there is no injury, an incident report does not need to be filled it if it is care planned as a behavior.

I guess that's one of the reasons we score so high for falls in our QI reports! We categorize falls according to the CMS definition, which is how it should be done. A roll out of bed is a fall, according to CMS. I have had other DONs tell me that they do not count "near misses" as falls. REally skews the numbers when we are not all on the same (ie CMS) page.

[joyflnoyz, LPN]

I just had this question at work Friday night, Resident with frequent falls. Low bed, with blue bounce pads. Called ADON, because I'd peviously been told a low bed with mats is no a fall if resident is on the mat. She said "The state has declared that "ANY change is elevation is a fall"" Dang it all. That means even if we see someone sliding a bit off the WC it's a "fall" HUH???

The job a Wally world handing out smiley stickers to the littel ones is looking better and better...

[emeraldjay]

In my opinion, when anything other than the feet touch the floor or mat, it's a fall. For those frequent fallers that like to get out of bed but can't walk, I've been known to hide wheelchairs in the bathroom, For some odd reason the-powers-that-be have forgotten how to remove temptation. Maybe it's coincidence, but many of our fallers don't seem to fall when the chair is out of sight, then again there are some that it just doesn't matter.

[annabrooke93]

I asked my DON the same question last week after this same incident happened on my shift and she told me this ..."Please remember the possibility of unseen injuries".. For example, the res may be on the floor, on the mat, from a bed in lowest position, BUT what if she hit her head on the bedside table and has an internal bleed that poses problems later? I had rather fill out the report and be safe AND avoid any possible guilt of being at fault if something did happen.

[Bellemccoy3541068]

In my world, if the bottom is on the floor, its a fall.

[suebird3]

In our facility, if a resident frequently rolls out of bed and there is no injury, an incident report does not need to be filled it if it is care planned as a behavior.

Yep.....same w/ my facility.

Suebird

[Bird2]

In our facility, if a resident frequently rolls out of bed and there is no injury, an incident report does not need to be filled it if it is care planned as a behavior.

Another problem with not making an incident is that the resident could have still been injured. Years ago I had a resident roll out of a low bed onto a mat and they fractured their wrist. Or ecchymotic areas could pop up a few days later leaving staff scrambling to do an abuse investigation.