Immediate Response to a Fall
When a resident falls, the first moments are critical. The immediate response should be calm, methodical, and focused on resident safety and comfort.
Do Not Move the Resident Immediately
Unless the resident is in immediate danger (e.g., in the path of a moving object or on a wet floor that cannot be dried), do not rush to move them. Instead, follow these steps:
- Stay calm and reassure the resident. Encourage them to remain still and breathe slowly.
- Assess the situation. Check for visible injuries like bleeding, bruising, or broken bones. Ask the resident if they feel any pain.
- Call for assistance. Use an emergency call bell or call for help from other staff members.
If Injuries Are Evident
If there is any sign of a serious injury, such as a head injury, severe pain, or inability to move a limb, the protocol dictates specific emergency actions:
- Immediately call for emergency medical services (911/ambulance).
- Keep the resident still and comfortable while waiting for help to arrive.
- Provide basic first aid for minor cuts or scrapes.
- Do not attempt to lift or move the resident alone, as this can worsen injuries.
The Post-Fall Assessment and Investigation
Following a fall, a thorough assessment is non-negotiable, even if the resident appears uninjured. The post-fall assessment is a critical component of the protocol to understand the root cause and prevent recurrence.
Evaluation and Monitoring (72-Hour Period)
The protocol requires increased monitoring for the resident for at least 72 hours after the incident. This includes:
- Regular vital sign checks. Temperature, pulse, blood pressure, and respiration rate should be monitored closely.
- Neurological checks. Staff should watch for any changes in consciousness, orientation, or cognitive status, particularly if a head injury is suspected.
- Pain assessment. Frequent checks for new or increased pain are necessary, as some injuries may present with a delay.
- Staff documentation. Every shift should include notes on the resident's condition, any treatments provided, and any changes in symptoms.
Investigating the Circumstances
An investigation must be carried out to determine the factors that led to the fall. This involves:
- Interviewing the resident. If possible, ask the resident what they were doing and what they remember happening.
- Reviewing the environment. Look for potential hazards such as cluttered walkways, poor lighting, or wet floors.
- Witness statements. Gather information from any staff or visitors who may have witnessed the fall.
- Equipment review. Check if any mobility aids or equipment were used improperly or malfunctioning.
Documentation and Communication
Comprehensive and accurate record-keeping is vital for regulatory compliance and ensuring continuity of care. It protects both the resident and the facility.
The Incident Report
Every fall must be documented in a detailed incident report. The report should include:
- Date, time, and location of the fall.
- Description of the incident, including what the resident was doing beforehand.
- Details of the resident's condition after the fall and any visible injuries.
- The staff's response and any immediate interventions.
- Communication records, including notifications to the primary care provider and family.
Family and Physician Notification
Open and prompt communication is a key element of the protocol. Family members or designated representatives, as well as the primary care provider, must be notified of the fall. The communication should include details of the incident and the plan for ongoing care and monitoring.
Revision of the Care Plan
Falls are often indicators that a resident’s needs have changed. A fall protocol requires a multidisciplinary review of the care plan following the incident. This is a crucial step in proactive prevention.
Post-Fall Multidisciplinary Meeting
The care team, including nurses, therapists, and the primary care provider, should meet to revise the resident's care plan. Interventions should be specific and tailored to the identified risk factors.
Common Care Plan Interventions
- Physical therapy evaluation: A therapist can assess the resident's balance, gait, and strength.
- Medication review: A pharmacist or physician should review all medications for side effects that could increase fall risk, such as dizziness or drowsiness.
- Environmental modifications: This can include adding grab bars, improving lighting, or removing trip hazards.
- Assistive device assessment: Ensure the resident has and properly uses appropriate mobility aids.
- Monitoring frequency: Increase the level of staff monitoring or use sensor devices.
Prevention vs. Response: A Comparison
Fall management involves both a reactive protocol (responding to a fall) and a proactive strategy (preventing future falls). The table below highlights the key differences.
| Feature | Fall Response Protocol | Fall Prevention Strategy |
|---|---|---|
| Timing | After the fall has occurred | Ongoing, proactive approach |
| Focus | Assessment, stabilization, and documentation | Risk factor identification and mitigation |
| Core Activities | Immediate evaluation, 72-hour monitoring, incident reporting | Regular risk assessments, medication review, exercise programs |
| Team Members | Attending staff, emergency medical services | Interdisciplinary team (nurses, therapists, doctors) |
| Goal | Minimize harm from the current fall | Minimize the likelihood of future falls |
The Role of Fall Prevention Programs
An effective aged care setting will have robust fall prevention programs in place as a preventative measure. Research-backed programs, like the CDC's STEADI initiative, provide excellent frameworks for risk reduction. These programs typically involve:
- Regular fall risk screening for all residents.
- Balance and strength exercises, such as Tai Chi, proven to reduce fall risk.
- Foot and footwear checks to ensure proper support.
- Vision assessments as poor eyesight is a major contributor to falls.
- Personal emergency response systems (PERS) for residents who need them.
Conclusion
Knowing what is the fall protocol in aged care is essential for all staff and provides reassurance to residents and their families. It is a comprehensive process that begins with immediate, cautious response and continues through detailed investigation, diligent documentation, and proactive care plan revision. By adhering to these protocols, aged care facilities can ensure that falls are not just reacted to, but also learned from, ultimately creating a safer living environment for all residents.
