Falls

In our LTC we have personal alarms placed on residents to notify staff and resident of unsafe movements related to residents inablility to recognize their own limitations. We place these on admission for 24 hours, if the resident uses their call light effectively, gait steady, etc we remove the PA. But if not, we continue with the PA. The question here is, if the resident is unsafe, constantely removes the PA dispite encouragement, should the PA be removed related to uncompliance? Understand resident rights and all, once we remove the PA then do we not need to implement another plan? Documentation on noncompliance is all well indeed but at least we are proving we are trying to protect the resident. But if we DC the PA with no other plan, can we be then held liable if she falls?

In a word: YES!

In theory, residents do have the "right" to fall. They also have a right to be protected from falls, and personal alarms are only one of the many weapons in the fall-prevention orificenal.

A word of caution: As an LTC assistant administrator and health services director, I'm uncomfortable with your facility's use of PAs on all new admissions regardless of diagnosis or cognitive status. Blanket policies like this violate a resident's right to be treated as an individual; in addition, your facility can be cited for failure to have an individualized, interim care plan in place within 8-24 hours of admission (check your state's regulations).

Anyway, it is NEVER a good idea to discontinue one type of fall prevention without having others in place. Even in ICF, you can request PT/OT evaluations to assist with planning a restorative program and acquiring the correct adaptive equipment that helps the resident move safely. Medications should always be reviewed to see if those that are likely to cause or contribute to falls can be D/Cd or changed to something less likely to do so. The resident's physician should also be consulted and appropriate tests done to rule out latent disease processes, such as MS and Parkinson's, that affect gait and muscle function. Check orthostatic BPs on a random basis to see if that could be causing falls.

These are only a few of the things we can do to prevent falls in LTC, but it's best to start with the basics. Again, I believe placing alarms on all new residents in lieu of a short, focused admission assessment is wrong; people do not give up their rights at the NH doorstep, and they don't deserve to be treated like cattle.

Good luck!