To Fall or Not To Fall?

[Tait, MSN, RN]

I am amidst a little Facebook discussion with an old boss of mine. The question is:

"If you are walking a patient and they suddenly become dizzy/unable to stand and you assist them by lowering them to the floor is this classified as a fall?"

Thoughts?

I personally did not see it as a fall, but preventing a fall. However there are some saying certain states, work environments (SNF in particular) do view this as a fall because it was "unplanned".

Tait

[Fribblet]

I don't see it as a fall either, but technically it is.

It's stupid in my opinion.

[TheCommuter, BSN, RN]

A former workplace of mine would describe the aforementioned type of situation as a 'controlled letdown' of the patient. However, nursing staff would still have to prepare an incident report and notify all of the appropriate parties such as the physician, nurse manager, next of kin, etc.

[LouisVRN, RN]

At our facility a fall is "any unplanned descent to the floor or a lower surface". So yes that would classify as a fall.

[jrw03282009]

I had never thought about that before! I would have said it wasnt a fall, but when you see the explanation of the term, then it would be a fall. Thanks for asking that one! (Learn something new every day!)

[pielęgniarka, RN]

Per CMS we have to consider that a fall and do all the neccessary follow up since it would be an "unintentional relocation to the ground". I suppose it helps to identify and address risk factors and treat the underlying medical condition blah blah blah. But the bummer is that falls are looked at as quality indicators of care, so it reflects badly on the nursing home no matter how great you are, just because you were taking care of wild or unstable residents that month. However if the patient said "I have to sit down right now on the ground because I'm dizzy" and you assisted that would be an" intentional relocation" to the floor therefore not a fall. I think.....

Per the MDS RAI manual:

a) An episode where a resident lost his/her balance and would have fallen, were it not for staff intervention, is a fall. In other words, an intercepted fall is still a fall.

b) The presence or absence of a resultant injury is not a factor in the definition of a fall. A fall without injury is still a fall.

c) When a resident is found on the floor, the facility is obligated to investigate and try to determine how he/she got there, and to put into place an intervention to prevent this from happening again. Unless there is evidence suggesting otherwise, the most logical conclusion is that a fall has occurred.

d) The distance to the next lower surface (in this case, the floor) is not a factor in determining whether or not a fall occurred. If a resident rolled off a bed or mattress that was close to the floor, this is a fall. The point of accurately capturing occurrences of falls on the assessment is to identify and communicate resident problems/potential problems, so that staff will consider and implement interventions to prevent falls and injuries from falls. In the instance of a resident rolling off a mattress that is close to the floor - even though this is still recorded as a fall, it might be true that staff have already assessed and intervened, and that placing a bed close to the floor to avoid injuries from falls is the intervention that best suits this individual resident.

[BluegrassRN]

At our facility a fall is "any unplanned descent to the floor or a lower surface". So yes that would classify as a fall.

My facility uses this definition as well. Where I work, the scenario would be classified as a fall.

[belgarion]

Where I work, if the patient goes down, it's a fall. It doesn't matter if it's controlled or not. In addition, if you go down controlling the fall, you fell too and have to fill out two incident reports. Plus, you go to the ED to be checked out.

[Selene006, BSN, LPN]

Where I used to work (SNF), it would be classified as a fall, and an incident report would have to be done. The patient would be classified as a "high fall risk" and the family/ guardian would be notified. If there were no bruises or injuries noted at the time of the "fall," then the patient would have neuro checks per protocol and would be closely monitored q shift for 72 hours for any change in status. The MD/ NP would be notified, and if the patient showed no signs of injury, the patient would remain in the facility. The care plan would have to be updated, maybe a bed wheelchair/bed alarm would be implemented.

[NotFlo]

Where I used to work (SNF), it would be classified as a fall, and an incident report would have to be done.. If there were no bruises or injuries noted at the time of the "fall," then the patient would have neuro checks per protocol and would be closely monitored q shift for 72 hours for any change in status. The care plan would have to be updated, maybe a bed wheelchair/bed alarm would be implemented.

Wow, some places really go to extremes. A lowered to the floor would be a fall in my facility. But why would you do neurovitals on a person that was lowered to the floor unless they hit their head? If the staff member that did the lowering and witnessed the event can affirm that the patient didn't hit their head we wouldn't do neurovits.

As far as alarms go, this is a classic example of misuse/overuse of alarms. The pt. was not trying to transfer or ambulate without assistance, so how is an alarm going to prevent them from being lowered to the floor again? Maybe their transfer status needs to be re-evaluated, maybe they were having some orthostatic hypotension and their BP meds need to be re-evaled, etc. but alarms are not going to do a thing for a person who got dizzy during transfer and had to be lowered to the floor.

[Fribblet]

Wow, some places really go to extremes. A lowered to the floor would be a fall in my facility. But why would you do neurovitals on a person that was lowered to the floor unless they hit their head? If the staff member that did the lowering and witnessed the event can affirm that the patient didn't hit their head we wouldn't do neurovits.

As far as alarms go, this is a classic example of misuse/overuse of alarms. The pt. was not trying to transfer or ambulate without assistance, so how is an alarm going to prevent them from being lowered to the floor again? Maybe their transfer status needs to be re-evaluated, maybe they were having some orthostatic hypotension and their BP meds need to be re-evaled, etc. but alarms are not going to do a thing for a person who got dizzy during transfer and had to be lowered to the floor.

Policy is not about applying clinical judgement to a situation. Policy is about stripping away clinical judgement and placing extreme safety measures like a blanket over a broad category (such as "falls"). This is to ensure that staff time is monopolized away from important matters, that mounds of paperwork will appear to drown the unfortunate staff member, and that the patient will be obtrusively monitored regardless of whether the situation calls for it. This is so that law suits are less likely.

This is also why nurses have become more task oriented, spend less time with patients, and do not have time to do basic nursing skills.

TL;DR: Mngmnt iz dum.

[CNL2B]

Policy is not about applying clinical judgement to a situation. Policy is about stripping away clinical judgement and placing extreme safety measures like a blanket over a broad category (such as "falls"). This is to ensure that staff time is monopolized away from important matters, that mounds of paperwork will appear to drown the unfortunate staff member, and that the patient will be obtrusively monitored regardless of whether the situation calls for it. This is so that law suits are less likely.

This is also why nurses have become more task oriented, spend less time with patients, and do not have time to do basic nursing skills.

TL;DR: Mngmnt iz dum.

Somewhat related --

At my facility, we CALL A CODE if somebody falls if it isn't in an inpatient area. I live in Minnesota. It gets icy in the winter, and sometimes the floors get really wet from snow being tracked in. Somebody falls outside of/inside of the front entrance at least once a week. In addition, our hospital has clinic/office space, which means we have a ton of geriatrics in their walkers tromping in and out of the building all the time. A diabetic faints in the cafeteria? Code. I swear codes get called 3-4 times a day here for stuff that has nothing to do with a cardiac arrest/respiratory arrest/true nonresponsiveness, etc. Talk about a waste of time/money/paperwork when 15 people have to respond to that crap.