DON Needs Suggestions

[PammyRN,CEN]

I am a fairly new DON been at it for a little over a year now. I have a large campus. My problem is we have had several falls with fractures. The fx's have occurred in various areas of the campus such as AL, Skilled and long term and AL Alzheimers several here. I am due for survey any day and I am very worried about this. I have inserviced on providing immediate intervention, had risk management come in to inservice on the falls from a risk management prospective, implemented staff have to notify me at the time of the fall day or night etc... inserviced again. Educated staff when falls occurred when assistive devices are not in place. Grrr.. we are a great facitilty, resident centered. We discussed this in QA etc... Do you have any suggestions for me so that I might minimize the severity of any cites? I am new to this building and it has been quite the challenge.

Also I am curious of the time of day any Ohioans have had their annual surveys?? I am told they are doing alot of off hours and weekends etc.. we staff heavy on the weekends so that doesn't really concern me..... just curious. QIS or traditional? I prefer QIS. Thanks for any suggestions even if you have a great careplan to share I would appreciate it.

Thanks,

Pam

[VivaLasViejas, ASN, RN]

As long as you and your staff can provide documentation that proves a) facility management is aware of the incident, b) you have done some detective work to try to find out WHY the resident fell, c) fall prevention methods specific to the resident's needs have been implemented, and d) you show a pattern of progressive interventions for any subsequent falls, you will probably do OK with survey.

It's when administrative staff fails to follow up and ensure that appropriate measures are taken to prevent the next fall that we are apt to find ourselves in hot water. We've all had residents who we can't keep off the floor no matter how many tab alarms, body pillows, fall mats and so on that we utilize; although some surveyors pretend they don't exist, every facility has its frequent fallers, and a time always comes when none of our interventions can keep them safe anymore. All we can do then is make sure that the resident has had labs/UA done, their meds have been reviewed and any unneeded drugs D/C'd, medical causes have been ruled out, and we've put in place all of the preventive equipment and frequent visual checks they need.

A side note about incident/occurrence reports: They are 'supposed' to be for in-house use only, but surveyors will almost always ask to see them if a concern is identified. They have the authority to do this; just don't make the mistake of volunteering your IR book or files....believe me, if they want to see them, they'll ask! It's also important to fill out these reports as thoroughly and accurately as possible, including witness statements, vital signs, and what was done immediately to prevent another occurrence as well as results of your investigation into the incident.

Hope this is helpful to you. I've been a DON in assisted living on and off for years, and I've learned all these things the hard way---through my own miscalculations and mistakes! It's a hard job, but as they say, somebody's gotta do it.

[PammyRN,CEN]

Thank You for the great advice, I appreciate it so much. You were very informative.

[justus501]

I think that any fall that resulted in more than minimal harm (ie a fracture) is at least a G at F323. If the facility has a history of multiple falls...it could be considered an Immediate Jeopardy. Just make sure you have documented well. The inservices are great, but what did you do to PREVENT the occurance from happening? Fall risk assessment? Care planning? Increased supervision?? All issues that will be considered.

Good luck with the survey. Hopefully it will just be state surveyors and not the Feds with them. :-)

[wyogypsy, RN]

We have safety device meeting every week and go over all falls for those coming up for MDSs. We also discuss all falls at stand up each morning and brainstorm. Sometimes the schedule has to be adjusted a bit on the unit - I used to watch the common area while the CNAs put the residents to bed that went down right away; then one of them would watch while I went and passed meds to the remainder of the residents. I have gone so far as to take a resident with me up and down the halls. Sometimes no matter what you do you can't prevent them, just make sure you have shown everything that you have tried, both before and after the fall. We have found that sometimes the monitors and alarms increase the resident's risk for falling as it agitates them. Best of luck and I wish one of us had a magical answer to share with each other!

[noc4senuf]

Make sure to have your MD or NP document in progress notes that the resident is at high risk for falls, fx, or trauma due to the poor choices they make and the staff and facility have done everything they could. we self report to the state multiple time per month. One was a fall with a fx and death within the week. All have been cleared since we have our ducks in a row.

[AUNTFESTUS]

The best advice i can give is actually work the floor yourself to actually see what i going on and where the weakness lies. This will solve about 75% of your problems. Chances are the QA team are just as eager to get their job done as you are so these simple remedies often get overlooked.