Frequent Falls

Yikes! We're required to get all the same info but fortunately we're still on a paper system so those fields we can't fill out don't keep haunting us. One of the many reasons I don't look forward to the inevitable point-of-care computer charting. We also have to write a careplan for each fall which also annoys the snot out of me. Why not just chart the fall under the Safety careplan which is started on admission? Fortunately, falls are seen as a good thing as far as supporting continued eligibility. There IS only so much you can do physically then you just educate, educate, educate! Some patients are going to fall because they are just too stubborn to admit they are not getting any better. At some point, we have to ALLOW them the right to fall. Medicare does not disagree. Ask any Ombudsman.

What are your procedures for patients who fall frequently? (Or any patient falls, for that matter). We spend A LOT of administrative time dealing with those frequent fall patients, particularly those in nursing homes.

We complete an electronic occurrence report from which we then generate a paper occurrence report for signatures. The RN must gather the obvious data--date and time of fall and what exactly happened. He/she must also document what interventions were taken to decrease the risk of falling again. A Fall Assessment is done in the electronic record. He/she must also document the full name of the individual reporting the fall, the full name and title of the person they discussed the interventions with, the full name of the family/POA they notified and certainly the date and time the physician was notified as well.

Any data incomplete results in the occurrence report being returned for completion. Sometimes we learn of the fall days to weeks after it occurred if the facility did not notify us in a timely manner. Regardless, all the data must be obtained. Obtaining full name and titles of individuals in the facilities is a huge difficulty here; tracking down workers in the nursing home or personal care home can be quite time-consuming.

Also, when you have a patient who falls frequently and you've put in a low bed, perimeter (or 'scoop' mattress), fall mats, bed alarm, recommended q1h rounding (um, yeah), gotten a PT eval .... what ELSE do you do? Our organization insists on finding more interventions and yet it seems we've exhausted our possibilities.

What does your organization do in these cases? Thanks!

Some patients will fall no matter what.

In home hospice those patients who cannot safely ambulate anymore often just transition to bed bound.

In facilities it is different. Everything must be done to prevent a fall but some patients will still fall.

The usual measures are bed/chair alarm, low bed with mats, scoop in mattress, appropriate foot wear if ambulating and anti slip socks, hourly rounding.

I am looking for policy regarding falls in the hospice patient population

Thanks in advance

Falls in facilities will vary with the facilities policy. Each hospice has their own policies. If you're looking to write your own policies than I would ask the facilities and local hospices for copies of theirs, go online and research, and go from there. Falls in house are rare in my experience.

If they fall and break something; is that where you're going with this?