Amy Stewart

We have several residents who fall frequently. How can we decrease the number of falls in our facility?

Start by identifying residents who are at risk for falls. Add timely communication about those at risk. 

Conducting a fall risk assessment is standard practice when a resident is admitted or readmitted. Accuracy and completeness are essential. Nurses assessing fall risk can gather some necessary information, such as a resident’s fall history, from past medical records. In-person observation can identify risk factors like balance, gait and strength deficits.  

Involving the resident’s family or representative can yield useful information. For example, if the resident was a farmer accustomed to waking early, this person may continue an early-rising routine. Resident-specific interventions are most effective at prevention, but obtaining these requires a detailed, accurate resident history. Annual fall assessment competency education for staff also can improve assessment quality.

Fall assessment results should be communicated to staff at all levels. This is to ensure that everyone is aware of a resident’s fall risk and any staff member can intervene or alert nursing if needed. Similarly, advise the resident’s family of intended interventions; their input can assist implementation. 

When a fall does occur, conduct a comprehensive root cause analysis of the incident. Interview all staff members working when the fall occurred, not just nurses. When gathering data from staff, ask how they think this specific fall could have been avoided. Direct care staff have good insight into avoiding future incidents, but may not speak up unless asked. Finally, conduct a post-fall debrief to explain the root cause of the fall. Emphasize new interventions to prevent future falls.