Fall investigation

[nrsejenna87]

Hello fellow nurses! I have recently started the daunting task of fall investigations and I am now responsible for implementing interventions. In my facility we do not use any type of restraints (no seat belts, lab buddies ect) we also do not have any alarms! So coming up with interventions is very challenging, especially for our frequent fallers. We have a fall investigation form that the floor nurses fill out when a fall happens. I then read through it to get an idea of what happened and why. This form in 3 PAGES LONG! I know my floor nurses are super busy, with all the documentation it takes roughly an hour to complete everything...which is crazy to me. So my question is how do other LTC facilitates go about fall investigations? what information is truly needed and most important. I am really trying to streamline this process so my nurses can get back to NURSING and caring for our elders...I feel like we spend more time a a desk documenting that actually doing patient care.

Any thoughts or suggestions? or if any would like to share the form they use that would be amazing!

[AliNajaCat]

I'd suggest your first action being going to the literature for support on fall prevention....and number one of those is bed/chair alarms. Then you have a conversation with your facility risk manager, bringing copies of your findings. Then you point out that preventing falls is smarter than continuing to investigate them over and over and over and over .... What's the point of that? Do they do something c the data these investigations produce? Or is that just what an old boss of mine used to call "mental masturbation"?

Suggest the RM compare the cost of just one fall (including the legal ramifications) with the cost of half-a-dozen bed/chair alarms

--> Bed/chair alarms for anyone identified at increased fall risk

Outcome: fewer falls .... and fewer investigations. Win-win all around.

[CoffeeRTC, BSN, RN]

Is this in addition to an event/ incident report? Why is is so long? Is is all about the falls or is there other material on the form that doesn't really apply?

I've filled in for our risk manager and I have a new appreciation for what they go through when investigating events. Since I am also working on the unit, I have a good idea of what the resident is like. Someone that doesn't work the floor, won't have this picture of the resident or unit. I really don't like the forms we use for events. They are way to broad and leave it up to the nurse or witnesses to fill out a narrative of the event. Things get missed and not noted. That being said, I can see how things need to be streamlined.

We have bed/ chair alarms, but I'm not sure if it really does cut down on the falls. The alarms are only effective if 1. they are actually turned on and 2. you have the staff to respond to the alarm. As far as interventions.. start from the top and work your way down.

When does the fall occur? is there a pattern? toileting issue, pain, hunger etc. Are they trying to get up to leave for work? (we had a dementia resident that was trying to get up to get ready for work around 4:30 am...solution was to get them up and dressed, out of bed and get an early breakfast)

Where does it occur? Are they being left in the dinning room unattended after dinner?

Look at positioning....are they trying to stand up because they haven't had a position change and are getting sore?

Are the W/C or bed wheels locked?

Are they bored? Is activities involved?

We don't use restraints either. We have 1 or 2 residents in a geri chair for comfort/ request and on occasion use a merrywalker (resident can get in and out of it on their own) so it can be tricky to prevent falls.