Fall incident?

allnurses Guide · Jul 5, 2012

You definitely need to familiarize yourself with your facility protocols, but

it does certainly vary, depending on where you work.

I used to consider a fall, to be when a patient or resident ends up on the

floor, involuntarily, on their own. This was pretty much the definition of a

fall at the very first facility where I worked as a nurse.

However, I used to work in a nursing home in which a fall was defined as:

ANYTIME a resident's knees touched the floor, for WHATEVER reason. We

used to have a resident who would place himself in the floor on his knees

because that is how he liked to PRAY. Everytime he did this, we had to

write it up.

In the facility that I work now, according to our education director... a fall

did NOT occur if it can be determined that a resident placed themself in

the floor voluntarily. However, if it was involuntary, even if they were EASED

to the floor by staff... it was a fall.

In the case you describe... if the resident's knees didn't even touch the floor,

then I wouldn't think it was a fall. But again, you need to familiarize yourself

with the protocols.

Double-Helix, BSN, RN · Jul 5, 2012

Who is your resource person for this job? Your charge nurse, ADN, DON, etc? Where is your policy and procedure manual? These should be the people/places you ask for questions like this- as it's important to accurately document falls when they take place- not when your shift is over and you've asked strangers on the internet who have no idea about your policies.

That being said, policies at LTC where I have worked have said that when a resident is guided to the ground it is not a fall. But that will vary from facility to facility, so it's important that you know what YOUR policies are regarding this. If you still are not sure about the answer, then give your supervisor a call and ask where you can find the information.

HelloM1M1 · Jul 5, 2012

Thanks! My supervisor was next to me when the PT described the event but she didn't tell me to initiate a fall incident report. I just want to ask for future references... but I guess I will have to check with my DON. The thing is the DON is new, this place just got renovated, and I'm just so overwhelmed with all the work (26:1 nurse, & we still have 5 beds open. Short-term rehab so all the patients are at higher acuity level than normal LTC), that I got no time to think or ask or check out policies. When I got home and woke up today I ran over the event yesterday and just freaked out, left a voicemail for my supervisor. What if it was a fall??? I didn't see the procedure manual that's why I'm so worried. I know it's not right to ask some strangers on some forum but I just needed some insights and no one is available at the moment. Thanks.

loveanurse777 · Jul 5, 2012

In our facility if a knee hits the floor it's a fall. Whether it is in slow motion or assisted. It is a fall. What you described did not qualify as a fall in my opinion.

I hate falls.

CoffeeRTC, BSN, RN · Jul 5, 2012

That wasn't a fall. If it was a true and actual fall and the PT witnessed it then we would have the PT initiat the incident report. The nurse would only be needed to do the assessment part. Some of our PT OTs are really great about doing their own incident reports too!

The resident kneeling on purpose to pray...I'd refuse to do the IRs. Could you have asked the resident to ask for assist and help them to the floor?

How about this other fun one...if they are in a low bed (even the super low beds where they are 5 inches from the floo) and roll onto a fall mat, we are supposed to do IRs on them. Yeah...fun!

allnurses Guide · Jul 6, 2012

That wasn't a fall. If it was a true and actual fall and the PT witnessed it then we would have the PT initiat the incident report. The nurse would only be needed to do the assessment part. Some of our PT OTs are really great about doing their own incident reports too!
The resident kneeling on purpose to pray...I'd refuse to do the IRs. Could you have asked the resident to ask for assist and help them to the floor?

I believe that yes, we had asked him to call for assistance but he never would.

Our doctor actually wrote an order to make sure that the resident in question always

got to attend church services, as an attempt to better fullfill his spiritual needs, so that

he would not... need to pray so much, I guess!!! =)

morte, LPN, LVN · Jul 6, 2012

my understanding is that any unintentional change of plane, or when that would have happened without intervention, is considered a fall. Under this definition, the OPs patient did indeed "fall".

frankie,RN · Jul 6, 2012

When in doubt do the incident report.that way you "CYA". incident reports are internal. so if they dont need it, they will shred it. but you dont want anyone coming to you and saying you didnt do one when you were supposed to. incident reports are indeed a pain in the butt. but they show that you performed your due diligence. best case scenario, she's alright and everythings ok. worst case scenario she has a busted knee that shows up a week later. when they investigate and find out that she hit her knee and it was witnessed, and no IR was completed, heads will roll. it takes 10 minutes to CYA- just cover your orifice.:)

CapeCodMermaid, RN · Jul 6, 2012

If the resident would have been on the floor without the PT's intervention, we'd consider it a fall.

I'm more concerned that the PT didn't call a nurse to assess the resident.

I'm revamping my facility's fall program. The incident report we have now.....23 pages long and that's for NO injury! Ridiculous. We all know old people fall. We should have interventions in place to prevent injury when they do fall.

amoLucia · Jul 6, 2012

As others have posted, know your agency's P&P; also ASK a NURSING SUPERVISOR when in doubt. Having said that --- being on the floor is NOT normal, therefore 99 44/100% times I'd be doing the full incident report portocol (witnessed, unwitnessed, knees down, butt down, low bed, other dept, whatever...) Best to err on the safe side. My worst scenario would be one week from then, that lady would complain to her family 'that she fell in therapy and she hurts a lot more now and... The family goes ballistic because they weren't notified and there's no documentation and nobody (ie. the current staff, not the involved staff) knows nuttin'... I can see it already, the phone call to the Dept of Health!

Therapy could have called nursing to check her out. My paperwork isn't 23 pages, but it is usually multiple documents, assessments, statements, referrals, care plan, etc and includes xeroxed packet for the DON office. A lot of stuff but better to CYA.