What constitutes a "fall" at your facility?

No Stars In My Eyes · Jan 5, 2015

Sounds like they need to have a document titled, "COULD Have Been A Fall; Covering Our A$$e$."

tnmarie · Jan 5, 2015

We have a younger res that acts out when you don't do what they want when they want. S/he sits down and then lays back in the floor. If we don't actually observe the res in the process of laying down, we have to chart it as a fall. We also have another res that gets down on their hands and knees and crawl around in the floor. Again: fall.

Our policy is that if any part of their body touches the floor, it's a fall. Legs hanging out of bed touching floor mats with bed in low position: fall; assisted to floor: fall; rolling out of low bed to floor mat: fall; lying in floor throwing tantrum: fall. We had a resident in a low bed in isolation that would "fall" every 10-15 minutes while awake (onto the floor mat of course).

That being said, I don't get the whole "when no part of the body is near the floor" thing you are talking about.

Also, just because it is supposed to be counted as a fall, I have a sneaking suspicion that they aren't always documented as such. More than once I was told by the CNAs that res x fell but the nurses didn't write it up as one. I never had the cahones. If they touch the floor: fall packet, period.

silverbat · Jan 5, 2015

According to CMS, if a resident changes the plane they are in, its a fall. Now, I did find that when I documentated that resident prefered to set on the floor, that was the patients right and I got an order that the pt dould so that, it was fine.

No Stars In My Eyes · Jan 5, 2015

According to CMS, if a resident changes the plane they are in, its a fall. Now, I did find that when I documentated that resident prefered to set on the floor, that was the patients right and I got an order that the pt dould so that, it was fine.

So funny to have a Doctor's Order for that!! But pretty smart move to bypass the stupidity !

VampyrSlayer, CNA · Jan 5, 2015

Our facility constitutes a fall as a change of planes. Even if you assist them

mmc51264, BSN, MSN, RN · Jan 5, 2015

Do ya get out the protractor? This seems so insane to me. How are you supposed to chart that!?!

THELIVINGWORST, ASN, RN · Jan 5, 2015

At our facility, patient goes "boom" or is found on the floor it is a fall. If it's assisted, it isn't.

No Stars In My Eyes · Jan 6, 2015

At our facility, patient goes "boom" or is found on the floor it is a fall. If it's assisted, it isn't.

Imminently sensible!

Here.I.Stand, BSN, RN · Jan 6, 2015

I'd have to look at our policy on that, since we don't have many falls in the ICU. When I worked in a SNF though, it was similar to what you describe--any contact w/ the floor.

Also though, if we were assisting someone and he got dizzy/weak and we had to help steady him, that was considered a fall. I thought that was stupid...I mean I just used my muscles to PREVENT him from falling! So I'll freely admit to never writing those up the way I did actual falls. I was busy enough without having to do a fall huddle and a full incident report, hourly VS/neuro checks for 4 hrs, call the MD/NP "Hey dr. K. This is Here.I.Stand, RN calling about Mr. Doe. I'm calling to report a fall which wasn't actually a fall, but I had to call you about it. No, he didn't injure anything. He didn't fall.... yes, I realize that you don't have any more time to take this call than I have to make it..." And then call the next-of-kin with a similar conversation... all for a non-fall. :sarcastic: Sorry, PTB...I or the CNA just PREVENTED a fall, and I'm not working one minute longer than I have to this shift. As it is, I already skipped lunch because I HAVE to leave on time to get my kids from school, because the school doesn't care if I'm an RN or not. I can't use my work as an excuse to be late.

Anyway, you see how I feel about policies about non-falls being treated as falls.

I was told in the AL portion of the facility, there was a resident w/ MS who fell several times per day. She was cognitively intact and was aware of her fall risk, and she chose to risk falling rather than give up her independence. So her RNs consulted with her family and provider, and then added it to her care plan that she was "allowed" to fall (not sure the exact wording, since I didn't work in the AL.)

amoLucia · Jan 6, 2015

According to CMS, if a resident changes the plane they are in, its a fall. Now, I did find that when I documentated that resident prefered to set on the floor, that was the patients right and I got an order that the pt dould so that, it was fine.

Smart idea!!!

And yes, some states are really stringent about falls/safety so employers are extreme sticklers for falls reporting. I could never figure out why a 'roll' from a floor mattress onto a floor eggcrate constituted a fall, :no: but my facilities did, so I did the paperwork they wanted. Same for an 'assisted' slide to the floor. And if you have to make phone calls about it, so be it. No use fighting it. You'll lose that battle.

Just one thing - you'd be surprised how pts, roommates and others perceive falls. All they say to the pt's family was "I (or "your Dad) was on the floor" and the family alarm bells ring off big time! Nothing worse than family who think you're hiding something by not telling them about 'being on the floor". "You know that Mama Bear mentality.

Then they call the State and State investigates. No paperwork or 'failure to follow facility P&P" will earn you a citation/deficiency.

And if a pt or a roommate, visitor or other staff even sniffs or whispers the word "FALL", I do the Full Monty. But I will document that 'the fall' was UNwitnessed or only REPORTED by whomever.

CYA :yes:

nursephillyphil, BSN, RN · Jan 6, 2015

the facility i used to work at said that "any change in center of gravity"is a fall, technically speaking if they move from sitting to standing or vice versa, it was a fall. if the pt bumped into a chair : fall, sit on toilet: fall, get up from toilet: fall so i decided the patients would all be on bedrest. JK! I think SNFs are on the uptick of decreasing falls as they get fined a lot for each one.