Documenting "Falls"

[HehLPN, LPN]

I am a nurse on the dementia unit. We have a resident who currently has a behavior of giving you a mean look, crossing his legs, and sitting on the floor when he doesn't get his way. If he is purposefully sitting on the floor to avoid care, why is that a fall? That, in turn, counts against the nurse and aides, as well as, the entire buildings fall count. Doesn't make sense to me.

[caliotter3]

If no one sees him get into this position, you can't really vouch that he did not fall. But if he sits down in front of you, I certainly wouldn't call this a fall.

[psu_213, BSN, RN]

I would chart exactly what you see.

"Resident observed in a sitting position on the floor. Alert…" etc. for an unwitnessed incident.

If it is witness chart "Resident states 'I don't want to take my meds.' Resident then lowered himself, untouched, to a sitting position on the floor. Resident did not hit his head while lowering himself onto the floor…etc." I have not worked in LTC for a while…and then it was as and aide, not an RN. At least as of then, the latter situation would count as a 'fall' also. If this does count as a fall, it is unfair to the staff and facility that this counts against them, but that is D/T the regulatory agencies and it stinks.

[VivaLasViejas, ASN, RN]

A fall is an unanticipated change in planes. If you see the resident lower himself to the floor intentionally, it's not a fall. Technically it is one if he's found on the floor with no witnesses to the "incident", so you need to CYA and document it the way you'd document any actual fall because you can't be certain that he DIDN'T fall. I'd also note any time he does his thing in front of staff because it may require care plan revision. Good luck, cases like this are very frustrating.

[Myapple77]

If you saw it with you own two eyes that he sat down on the floor, or if someone saw it that he did it purposely then it is not a fall. But If let's say you went to his room and saw him sitting again on the floor and no one knows if he fell or what, then you have to document it.

[Myapple77]

I also forgot that you need to document that he did it intentionally. I mean just to cover yourself. If you work in LTC everything that you do has to be documented.

[lumbarpain, ADN, RN]

We have the same crazy thing at my job.....we were told, if a Patient was looking for her shoes under the bed...and she was on her knees searching for them...its a fall..and you have to fill out all this paperwork even though she said she didn't and was just looking for her shoes....ITs a stupid thing someone on the higher up scale invented that had nothing else to do one rainy night so they made this up...I find it absolutely ridiculous when the patient is clearly JUST DOING SOMETHING IN REGARD TO NORMAL ACTIVITY ....NOW if she bent down and slipped and hit her chin or something else while looking...yes....but just simply searching for an item...its NOT A FALL and shouldn't be documented as one....stupidity is abundant.

[CaringGerinurse525]

We had a resident that had the same behavior. She would say "now you'll have to give me attention" the. Lower herself to the floor. We were required to write it up as a fall. 😒 We also had a resident who liked to pray while down on his knees with his hands folded on the bed. My DON had us charting that as a fall as well! It was ridiculous. Finally the doctor got sick of it and wrote an order that resident could pray in that position.

Honestly, sometimes I don't know what they are thinking!

[LadyFree28, BSN, LPN, RN]

We had a resident that had the same behavior. She would say "now you'll have to give me attention" the. Lower herself to the floor. We were required to write it up as a fall. 😒 We also had a resident who liked to pray while down on his knees with his hands folded on the bed. My DON had us charting that as a fall as well! It was ridiculous. Finally the doctor got sick of it and wrote an order that resident could pray in that position.

Honestly, sometimes I don't know what they are thinking!

Unfortunately, since LTC is highly regulated due to some unfortunate incidents that occurred and to prevent future litigation and/or liability; if a pt is on the floor-it can be considered a "fall" even though they are not even falling not have a fall risk.

The minefields of working in LTC.