Falls!!!!Falls!!!!!Falls!!!!!!

[texas tea]

State in and they sited us for not doing an in-service when a resident falls. We do a yearly in-service but not after every fall. They highly sugguest we start doing this. Does anyone else do this

[VivaLasViejas, ASN, RN]

I was a surveyor for a little while and I never heard of any such thing. Of course, states have their own way of doing things, but I'm aware of no federal regulations regarding in-services for *all* falls. My word, if you held one every time someone took a spill, the staff wouldn't have time to do anything else! I suspect what your LTC was cited for was failure to follow up properly on falls and careplan appropriately...maybe you're also expected to hold an in-service every certain number of months, e.g. quarterly or every six months. I would definitely ask the surveyors to clarify. Good luck, and welcome to Allnurses!

[amoLucia]

Might it be that your facility had an unusually high (higher that the avg statistic) occurrence of falls.? And were they the 'serious' ones resulting in fractures or TBIs? That may be why they could be citing you.

Also, how's your care planning and safety/falls risk programs? If they're lacking and you've a significant falls incidence, they see a need to cite you for your improvement.

Just to tell you - if they want you to do inservice per fall incident, then just do it. They'll be watching you. But in your plan of correction, time limit yourself into a 'limited time period' (or else you'll be required to continue until the year 2525!)

Unless they're telling WHAT you must cover, do your own thing, SHORT, SWEET, and BRIEF. Let shift supervisors do a review and everybody signs in.

To be honest, just a yearly presentation just doesn't sound enough to me.

[Double-Helix, BSN, RN]

I'm not in a nursing home, but after every fall on our unit we do a review of the event and identify potential causative factors. Such as- was the bed not lowered? Were the side rails down? Was the room cluttered? Did the patient have access to the call bell? Then we disseminate the lessons learned” to staff via email and morning huddle. It's not an inservice as much as it is creating awareness of risk factors so that staff can be more mindful.

[texas tea]

Thanks for the replies. This wasn't a survey. This was a follow-up post a fall. The resident has had many falls in the past, wears a alarm, but has dementia, we followed proper protocols notifying the state, post fall investigating etc. I am sorry I said cited us she did not cite us, she said that she would recommend that we do this after each fall. I wish all residents had a budge cord.

[CapeCodMermaid, RN]

Alarms do not prevent falls any more than writing interventions in a care plan does. People are going to fall.

Every surveyor likes things done their way. I've been in the business forever and have never had a surveyor suggest we inservice after every fall. One patient fell 8 times in 6 months. We thought of every intervention known. She was newly diagnosed with AFib and flat out refused any assistance despite hours of teaching and trying to convince her. The survey team was going to cite us on one of the eight falls because she said we should have been in the room with the patient. That would clearly been against the woman's right to privacy and to run her life as she wanted. She was totally alert and oriented and stubborn as the day is long. We ended up not getting cited but only because the patient spoke to the surveyor and told her her privacy meant everything to her and she would rather potentially fall than have someone watch her get dressed.

[Natasha A., CNA, LVN]

CapeCodMermaid, i love reading different patient stories to help learn as well. I am curious if hourly rounds helped or at least knowing the behavior pattern of the resident? Was data collected to get a trend when she fell the most (ie day vs night, after medication times, when needed to use the bathroom, etc) Would it have helped to do a 1:1 in front of her room to not invade her privacy?

[CapeCodMermaid, RN]

It's been my experience that 15 minute checks or hourly rounds do little good in preventing falls. Many thing can happen in an hour. We should always try to find out why the resident fell. In this lady's case a 1:1 wouldn't have done much good. She closed her door when she was getting dressed. Luckily she never hurt herself and the team thought the benefit of her being able to maintain her independence outweighed the risk of another fall.

[Natasha A., CNA, LVN]

It's been my experience that 15 minute checks or hourly rounds do little good in preventing falls. Many thing can happen in an hour. We should always try to find out why the resident fell. In this lady's case a 1:1 wouldn't have done much good. She closed her door when she was getting dressed. Luckily she never hurt herself and the team thought the benefit of her being able to maintain her independence outweighed the risk of another fall.

Well, hopefully your case study will help others. Thanks!

[calliehobb]

Hi everyone,

im a caregiver. There was a patient who fell face first and broke her neck. She was moved due to the fact that she was face down. How do you recommend we move a patient who is face down safely after a fall?

[CapeCodMermaid, RN]

We never move someone who doesn't have full range of motion. Too dangerous to the patient and the staff. Call EMS. They are trained to do this

[Nascar nurse, ASN, RN]

Just a recent observation regarding falls in my own facility. I've been the DON of a small rural 42 bed facility for about 6 months now. When I started they had approx 15 personal alarms and averaging about 12-15 falls a month. The admin who hired me asked in the beginning to see what I could do about drastically reducing alarms. Mid April I got rid of the very last alarm and we are officially a restraint/alarm free facility. I added just a few new interventions where merited, but really not much.

The staff and families have made multiple comments over how quiet it is in our building now. "Peaceful and calm". Here's the amazing part....in March we had 6 falls and in April we have ONE fall. I really believe it has nothing to do with a few of the interventions that I initially sprinkled in at the beginning and lots more to do with the "Peaceful/Calm" environment we've created.

Bonus: The staff thought the "new DON" had to be crazy at the announcement that we would be an alarm free facility within 6 months. Now they think the "new DON" is a miracle worker. :)