A fall in an aged care setting triggers a critical series of actions to ensure the resident's immediate safety and long-term well-being. A robust and well-practiced post-fall protocol is essential for every facility. This process moves from a rapid, on-site response to a detailed, multi-disciplinary review aimed at mitigating future risk. Following a fall, staff should never assume the absence of injury, even if the resident reports feeling fine.
The immediate post-fall response
When an aged care resident falls, the first priority is to ensure their immediate safety and medical needs are met. This requires a calm, systematic approach from trained staff.
Step 1: Assess and stabilize the resident
- Do not move the resident immediately. Unless they are in immediate danger (e.g., in a path of traffic), wait until a full assessment has been conducted. Moving a person with a spinal or other internal injury can cause more harm.
- Perform a primary survey. Check the resident's airway, breathing, and circulation (DRSABCD). If unconscious or in cardiac arrest, initiate basic life support and call for emergency services immediately.
- Conduct a head-to-toe check for injuries. While reassuring the resident, look for visible injuries like bruises, cuts, deformities, or signs of head trauma. Check for pain, especially in the neck, spine, and hip.
- Take vital signs. Record blood pressure (including postural readings), pulse, respiration rate, and conscious state.
Step 2: Notify and document
- Alert the registered nurse or facility manager. The most senior staff member on duty must be informed to oversee the post-fall process.
- Document the incident. Thorough and accurate documentation is critical. A detailed incident report should be completed, including the time, date, location, resident's activity before the fall, and any witnessed factors.
- Notify the family. Open disclosure and timely communication with the resident's family or designated representative are essential ethical and legal responsibilities.
Post-fall assessment and investigation
Within 24 to 72 hours of the incident, a more comprehensive review is necessary to understand the contributing factors and prevent future falls. This is typically led by a multidisciplinary team.
Step 3: Medical and medication review
- Comprehensive medical evaluation. The resident's physician or nurse practitioner should be notified and review the resident's medical condition. This might include ordering diagnostic tests like X-rays, blood tests, or ECGs to rule out underlying medical issues.
- Medication management. A pharmacist or physician should review all current medications. Drugs that cause sedation, dizziness, or affect blood pressure can increase fall risk.
Step 4: Environmental and risk factor analysis
- Investigate the fall circumstances. Staff should examine the fall location for any environmental hazards, such as spills, uneven flooring, poor lighting, or misplaced equipment.
- Assess intrinsic risk factors. A reassessment using a validated fall risk tool (e.g., Hendrich II scale) is crucial. This includes evaluating the resident's mobility, balance, vision, and cognitive status.
Developing and implementing a new care plan
The insights gained from the investigation are used to develop a revised, personalized care plan. This is a collaborative effort involving the resident, family, and the care team.
Step 5: Implement targeted interventions
- Enhance supervision. Increase monitoring for residents at higher risk, especially during critical periods like the night or transfers.
- Modify the environment. Implement changes such as removing clutter, installing grab bars, improving lighting, and using non-slip mats.
- Promote mobility. Incorporate tailored exercise programs to improve strength, balance, and gait. Use appropriate assistive devices and ensure proper footwear is worn.
- Provide education. Educate the resident, family, and staff about the specific fall risks and the new interventions.
Comparison Table: Reactive vs. Proactive Fall Management
| Feature | Reactive (Basic Post-Fall Response) | Proactive (Comprehensive Fall Management) |
|---|---|---|
| Focus | Injury assessment and documentation. | Root cause analysis and prevention. |
| Timing | Immediate after the fall. | Ongoing and long-term. |
| Responsibility | Primary care staff involved in the incident. | Multidisciplinary team (nurses, physicians, therapists, families). |
| Outcomes | Addresses immediate safety and legal requirements. | Reduces future fall risk and improves resident quality of life. |
| Scope | Individual incident analysis. | Individual and systemic analysis. |
| Care Plan | Minimal or ad-hoc adjustments. | Fully revised and personalized plan with specific interventions. |
Conclusion
Understanding what is the post fall protocol in aged care is more than just a procedural requirement; it is a critical component of providing high-quality, person-centered care. The process requires a swift and decisive immediate response to ensure resident safety, followed by a thorough investigation to determine all contributing factors. By transitioning from a reactive stance to a proactive, continuous improvement model, aged care facilities can significantly reduce fall incidents and their associated injuries. The comprehensive process of assessment, intervention, and communication not only enhances the safety of residents but also empowers them by addressing their underlying health and environmental needs. For more information on facility-wide fall prevention, organizations like the Agency for Healthcare Research and Quality (AHRQ) provide valuable resources.
