What should the nurse aide do if a resident starts to fall?

According to the CDC, over one in four older adults fall each year, making knowing exactly what should the nurse aide do if a resident starts to fall a critically important part of providing safe and effective care. This authoritative guide details the proper response protocol to protect both the resident and the caregiver from harm.

Quick Summary

The correct action is to protect the resident by bringing them close to your body and gently lowering them to the floor in a controlled manner, rather than attempting to stop the fall completely. After the resident is safely on the floor, the aide should call for help, assess for injuries, and provide reassurance while awaiting assistance from a licensed nurse.

Key Points

• Controlled Slide Technique: A nurse aide should pull a falling resident close and use their leg to guide them gently and safely to the floor, minimizing impact.

• Protect the Head: As the resident is being lowered, the aide must use their body or arms to shield the resident's head from hitting the hard floor surface.

• Never Attempt to Stop: The aide should not try to hold the resident upright, as this can cause severe injury to both the resident and the caregiver.

• Call for a Nurse Immediately: After the resident is safely on the floor, the aide's next action is to call for a licensed nurse to perform a medical assessment.

• Assess and Reassure: While waiting for help, the aide should visually check for obvious injuries and calmly reassure the resident, instructing them not to move.

• Document Everything: A detailed incident report is required, noting the time, location, circumstances of the fall, and any observable injuries.

Understanding the 'Controlled Fall' Technique

In the moment a resident begins to lose their balance, an untrained instinct might be to try and stop the fall completely. This is often dangerous for both the resident and the nurse aide, as it can lead to worse injuries for the resident (such as a fracture from a jarring stop) and potential back injuries for the aide. The safest and most widely taught procedure is the controlled fall technique, which minimizes the impact of the landing.

Performing the Controlled Slide

If you are near a resident who is beginning to fall, follow these steps:

1. Use a wide base of support: As the resident starts to sway or buckle, immediately widen your stance to create a stable base. This lowers your own center of gravity and prepares you to support their weight.
2. Pull the resident close: Grasp the resident firmly, ideally around their waist or with a gait belt if one is in use. Pulling them toward your body helps to keep their weight close to your center of gravity, giving you more control.
3. Bend your knees: Instead of bending at the waist, bend your knees and keep your back straight. This uses the stronger leg muscles to support the weight and prevents back strain.
4. Slide the resident down your leg: Use one of your legs as a support beam, sliding the resident's body down the front of your leg to the floor. As you slide them down, continue to lower yourself by bending your knees.
5. Protect the head: As the resident gets closer to the floor, use your arms and body to protect their head from hitting the hard surface. Guide their head so it lands gently, cushioning the impact.

Post-Fall Protocol

Once the resident is safely on the floor, the immediate crisis has passed, but the work is not over. The following steps are crucial for ensuring the resident's well-being and proper documentation.

Step 1: Call for Help and Reassure the Resident

Immediately use the call bell or shout for a licensed nurse and other assistance. Your primary role now is to keep the resident calm. Speak in a reassuring voice, tell them what you are doing, and instruct them to remain still while you wait for help to arrive. Do not attempt to get the resident back up on your own.

Step 2: Assess the Resident from Head-to-Toe

While waiting for assistance, perform a quick visual assessment. Check the resident for any obvious signs of injury, such as bleeding, bruising, or deformity of a limb. Ask them if they feel any pain and where. Never move the resident if you suspect a head, neck, back, or hip injury. A licensed nurse will perform a full medical evaluation before any movement.

Step 3: Document the Incident Thoroughly

As soon as possible, you will need to complete an incident report. Accurate documentation is vital for the resident's medical record and for identifying potential fall hazards. Be sure to include:

• The date and exact time of the fall.
• The location where the fall occurred.
• A detailed description of the incident, including what the resident was doing at the time.
• Any pre-fall indicators or statements the resident made.
• The resident's response and any visible injuries observed.
• The actions you took immediately following the fall.

Comparison of Fall Responses

Feature	Controlled Slide (Proper Technique)	Attempting to Stop (Improper Technique)
Resident Safety	Minimizes impact, protects head, reduces risk of fractures.	Increases risk of fractures, sprains, or other trauma due to abrupt stop.
Caregiver Safety	Protects the back and joints by using proper body mechanics.	Can cause severe back, neck, or shoulder injuries from strain.
Outcome Control	Guide the fall to the safest possible landing.	Loss of control, leading to an unpredictable and potentially more dangerous fall.
Protocol	Standard practice taught in all certified programs.	Often an instinctive, untrained reaction that should be avoided.

Identifying and Mitigating Environmental Risks

While responding correctly to a fall is crucial, the ultimate goal is preventing them from happening in the first place. Nurse aides play a key role in identifying and reporting environmental hazards. This includes:

• Clear Pathways: Ensuring walkways are free of clutter, cords, and furniture.
• Proper Lighting: Reporting dim lighting or burnt-out bulbs, especially in hallways, stairways, and bathrooms.
• Secure Flooring: Notifying staff of any loose rugs, uneven flooring, or slippery surfaces.
• Accessible Equipment: Confirming that walkers, canes, and wheelchairs are within easy reach.
• Safe Footwear: Encouraging residents to wear appropriate, non-skid footwear.

For more detailed information on fall prevention strategies and best practices, it is beneficial to consult resources from organizations such as the Agency for Healthcare Research and Quality. Regular training and continuous communication are the best defenses against resident falls.

Conclusion

Understanding what to do if a resident starts to fall is a fundamental part of a nurse aide's job. By mastering the controlled slide technique, following the correct post-fall protocol, and actively working to mitigate environmental risks, caregivers can significantly improve resident safety. This approach not only protects residents from severe injury but also ensures the safety and well-being of the care team. Always remember to prioritize safety, stay calm, and call for professional medical assistance.

Frequently Asked Questions

What is the very first thing a nurse aide should do when a resident begins to fall?

The very first action is to protect the resident by moving in close, using a gait belt if available, and performing a controlled slide to gently lower them to the floor while protecting their head. Do not try to catch or hold them upright.

Should a nurse aide ever try to stop a resident's fall completely?

No, a nurse aide should never try to completely stop a resident's fall. The force required can cause injury to both parties. The goal is to control the fall and minimize the impact, not to prevent it entirely.

After the resident is on the floor, what should the nurse aide do next?

After the resident is safely on the floor, the aide should immediately call for help from a licensed nurse. While waiting, the aide should stay with the resident, reassure them, and perform a visual check for obvious injuries without moving them.

When is it safe to move a resident after a fall?

A nurse aide should never move a resident after a fall, especially if there is any suspicion of a head, neck, or hip injury. Only a licensed nurse or other trained professional should determine if it is safe to move the resident, often after a full medical assessment.

What information should be included in a fall incident report?

A fall incident report should include the date, time, and location of the fall, what the resident was doing at the time, any observed injuries, statements from the resident, and the actions taken by the staff. Accurate documentation is critical.

What if a resident is wearing a gait belt when they fall?

If a resident is wearing a gait belt, the nurse aide should use it to their advantage. Grasp the belt firmly with one hand while supporting the resident's shoulder with the other, then perform the controlled slide technique to lower them to the floor safely.

What is the best way to protect a resident's head during a fall?

To protect a resident's head, position your body to guide their head away from hard surfaces and cushion the impact as they are lowered. You can use your arm, shoulder, or thigh to soften the contact with the floor.