Immediate Action: The Controlled Lowering Technique
When a resident begins to lose their balance, the natural instinct may be to try and stop the fall completely. However, attempting to catch a falling adult can lead to serious injury for both the resident and the CNA, due to the unexpected weight and shift in balance. The medically approved procedure is a controlled lowering. This technique involves guiding the resident safely to the floor to minimize impact and reduce the risk of fractures or head injuries. A CNA's quick, calm, and trained response is paramount in such a situation.
Step-by-Step Guide for Controlled Lowering
For a CNA, executing a controlled fall is a critical part of emergency training. Proper body mechanics are crucial for protecting your own back while ensuring the resident's safety.
- Widen Your Stance and Maintain Balance: As soon as you feel the resident losing their balance, widen your legs into a strong, stable base. This lowers your center of gravity and increases your stability.
- Pull the Resident Close: Immediately pull the resident towards your body using the gait belt. Keep them close to your center of gravity to maintain control. Never try to stop the fall by grabbing their arms or clothing, as this can cause dislocations or skin tears.
- Bend Your Knees: Bend at your knees, not your waist. This engages the powerful muscles in your legs and keeps your back straight, preventing a back injury.
- Slide the Resident Down Your Leg: With the resident supported by your body and the gait belt, extend one of your legs and place it between the resident's legs. Slowly slide the resident down the front of your leg to guide them gently to the floor.
- Protect the Resident's Head: As the resident is being lowered, use your arms to protect their head from hitting the floor or any nearby objects, such as furniture.
- Position the Resident: Once on the floor, position the resident safely and securely. Do not attempt to move them until a full assessment has been completed.
Procedures After the Fall
The CNA's responsibility does not end once the resident is on the floor. A specific set of protocols must be followed to ensure the resident's continued safety.
- Stay with the Resident and Call for Help: Use the call light or call out for a nurse or another staff member. Do not leave the resident unattended to go find help. Reassure the resident that you are there to help and that assistance is on the way.
- Assess for Injuries (Do Not Move): While waiting for help, visually and verbally assess the resident for injuries. Look for signs of pain, bleeding, or deformities. It is critical that you do not move the resident unless they are in immediate danger. Moving an injured resident, especially one with a potential head or spinal injury, can cause further harm.
- Wait for the Nurse: The nurse or supervising staff member must conduct a full medical assessment. Only a registered nurse can determine if it is safe to move the resident and what method should be used.
- Complete the Incident Report: Once the situation is stabilized, an incident report must be completed according to the facility's policy. The report should detail the circumstances leading up to the fall, the CNA's actions, and the resident's condition afterward. This documentation is vital for legal purposes and for identifying patterns that can prevent future falls.
Correct vs. Incorrect Fall Response
Proper training on what should the CNA do if the resident starts to fall while he is ambulating her hinges on understanding the difference between proper procedure and dangerous instinct. This table clarifies the distinction.
| Correct Action (Do) | Incorrect Action (Do Not Do) |
|---|---|
| Use the gait belt to maintain control. | Attempt to catch the resident and stop the fall. |
| Widen your stance and bend your knees. | Brace your legs or attempt to lift the resident up. |
| Gently lower the resident to the floor. | Move out of the way and let the resident fall uncontrolled. |
| Protect the resident's head as they descend. | Neglect to protect the resident's head from impact. |
| Stay with the resident and call for help. | Leave the resident to find help. |
| Assist the nurse with assessment. | Attempt to help the resident stand up without a nurse's approval. |
Fall Prevention as a Proactive Strategy
While knowing how to respond to a fall is vital, preventing falls in the first place is the most important part of a CNA's job. This proactive approach includes:
- Ensuring the Environment is Safe: Keep walkways clear of clutter, ensure good lighting, and make sure residents' footwear is appropriate and non-slip.
- Monitoring Resident's Condition: Be aware of changes in a resident's physical or mental state that could increase fall risk, such as dizziness, confusion, or increased weakness.
- Assisting with Ambulation Properly: Always use a gait belt when assisting residents who are at risk of falling. This provides a secure point of contact for the caregiver to maintain control.
- Encouraging Exercise: Safe, approved exercise can improve a resident's strength and balance, reducing their risk of falling. Activities like walking or Tai Chi are often used in senior care facilities.
Documentation and Communication
Detailed and accurate documentation of a fall is critical. This includes:
- Time and location of the fall.
- Description of the fall: What happened, and what did the resident say?
- The CNA's actions: How you responded to the fall.
- The resident's condition immediately after the fall: Any visible injuries, complaints of pain, or changes in consciousness.
- Notification of the nurse and family: All relevant parties should be informed promptly according to facility protocol.
Conclusion
Successfully managing a resident's fall during ambulation is a core competency for any CNA. The correct response, which is to perform a controlled lowering, protects both the resident from severe injury and the CNA from potential back injuries. Adhering to the post-fall protocol of assessing, calling for help, and documenting ensures that the resident receives proper medical attention and that the facility's safety standards are upheld. By combining vigilant fall prevention strategies with sound emergency response techniques, CNAs play a critical role in promoting a safe and healthy environment for senior residents.
