What to do if a resident falls in aged care? A Comprehensive Guide

According to the Agency for Healthcare Research and Quality, 30-40% of aged care residents who fall will do so again, making a prompt and effective response critical. Knowing exactly what to do if a resident falls in aged care is essential for staff and families to minimize injury and prevent future incidents.

Quick Summary

When a resident falls, the first priority is to assess for injuries and call for assistance, following the facility's specific protocol. Do not move the resident unless they are in immediate danger. After initial care, a thorough investigation must occur to identify the cause and update the resident's care plan to prevent future falls, with all actions meticulously documented.

Key Points

• Do not move the resident: Assess for injuries first, and if a serious injury is suspected, wait for medical professionals before moving the resident.

• Call for help immediately: Always alert senior staff or a nurse, and summon emergency services (999/911) if the resident is seriously injured, unresponsive, or in severe pain.

• Document everything: A detailed incident report must be completed, recording the circumstances, resident outcome, staff response, and any follow-up actions.

• Investigate the cause: Conduct a thorough review of the incident, interviewing witnesses and analyzing environmental factors to determine the root cause.

• Adjust the care plan: Use the investigation findings to implement new interventions in the resident's care plan to prevent re-occurrence.

• Ensure transparent communication: Keep the resident's family informed of the incident, the investigation findings, and the revised care plan.

Immediate Response to a Resident Fall: The First 15 Minutes

The moments immediately following a resident's fall are critical. Your actions can significantly impact the outcome, potentially preventing further injury. Acting calmly and methodically is paramount, starting with a crucial first assessment and securing the scene.

Assess the Situation and Ensure Safety

1. Do not rush to move the resident. Your first instinct might be to help them up, but this can cause greater harm if they have an unrecognized head, neck, or back injury. Maintain a safe distance and observe.
2. Assess the immediate environment for danger. Remove any immediate hazards, such as spilled liquids, broken items, or furniture that could cause a secondary accident. Protect yourself and the resident.
3. Perform an initial head-to-toe assessment from a safe distance. Speak to the resident, asking if they are in pain and checking for visible injuries, swelling, or changes in consciousness. A simple check of their responsiveness and orientation can provide important clues.

Call for Assistance and Medical Evaluation

1. Alert senior staff immediately. Use the facility's designated emergency bell or call system. It is important that a registered nurse or other authorized medical professional conducts the detailed clinical assessment.
2. Call emergency services if necessary. If the resident is unconscious, bleeding heavily, in severe pain (especially head, neck, or hip), or if their condition is deteriorating, call 911 (or local emergency number) immediately. Do not delay this step.
3. Provide reassurance. While waiting for assistance, speak calmly to the resident. Cover them with a blanket to prevent shock and maintain their dignity.

The In-Depth Post-Fall Investigation

Once the resident has been safely managed and medical needs addressed, a thorough investigation is essential. This process is not about assigning blame but about understanding the event to prevent its recurrence.

Gathering Crucial Information

• Interview witnesses: Speak to anyone who saw the fall, including other residents or visitors. Their perspective can provide valuable context.
• Interview the resident: If the resident is lucid, ask them about the events leading up to the fall. Did they feel dizzy? Did they trip over something? Were they rushing to the bathroom?
• Analyze environmental factors: What was the condition of the area where the fall occurred? Was the floor wet? Was there clutter? Was lighting adequate? Was the equipment, such as a walker or wheelchair, working correctly?
• Review the care plan: Examine the resident's existing care plan. Was it up-to-date? Were fall prevention protocols being followed? Was there a recent change in medication that could increase the risk of falls?

Documenting the Incident Meticulously

Comprehensive documentation is legally and clinically critical. It ensures continuity of care and helps in analyzing trends to improve safety.

• Complete a detailed incident report. This should include the date, time, and location of the fall; a description of the event; the resident's condition before and after; a list of any injuries found; the staff response; and notifications made.
• Use a falls tracking tool. Many facilities use a standardized form, such as a TRIPS (Tracking Record for Improving Patient Safety) form, to capture all relevant details.
• Document all follow-up care. Record all monitoring, tests, and referrals requested in the resident's medical chart.

Comparing Post-Fall Response Strategies

Feature	Immediate Care Plan Adjustment	Comprehensive Fall Management Program
Scope	Addresses the individual resident's incident.	A systemic approach to fall prevention across the entire facility.
Actions	Revises the individual care plan with targeted interventions (e.g., increased toileting assistance).	Analyzes aggregated data to identify facility-wide trends and risks.
Focus	Reactive, responding directly to the specific fall event.	Proactive, aiming to prevent falls before they happen.
Participants	Interdisciplinary team involved with the resident (nursing, therapy).	Wider team, including managers, quality assurance, and all frontline staff.
Effectiveness	Essential for preventing re-injury of a specific resident.	Reduces overall fall rates across the facility and improves safety culture.

Implementing Fall Prevention Strategies

Following a fall, updating the resident's care plan with specific, evidence-based interventions is essential. This might involve:

• Medication Review: Consulting with a physician or pharmacist to review all medications. Some drugs, like sedatives or diuretics, can increase fall risk.
• Mobility Assessment: Working with physical therapy to improve strength, balance, and gait. This may include recommending new or properly fitted mobility aids, such as a walker or cane.
• Environmental Modifications: Ensuring the resident's room is free of clutter, has adequate lighting, and that personal items are within easy reach.
• Increased Monitoring: For high-risk individuals, this could include more frequent staff checks, sensor devices, or bed alarms.

Communication with Family Members

Transparent and timely communication with a resident's family is a crucial part of the post-fall process. Promptly notifying the next of kin is mandatory and helps build trust.

• Initial Notification: Provide a factual, calm account of the incident, including the immediate steps taken and the resident's current condition.
• Follow-Up Discussion: Arrange a time to discuss the findings of the investigation and the new or revised care plan. Listen to their concerns and incorporate their insights.
• Maintain Ongoing Communication: Keep the family informed about the resident's recovery and any new prevention strategies being implemented.

Continuous Monitoring and Improvement

A single fall is an opportunity for learning and improvement. Ongoing observation is required after any fall, as some injuries may not be immediately apparent. For instance, a person on anticoagulant medication requires extra observation for potential internal bleeding. Regular reviews of the care plan and staff compliance are necessary to ensure interventions remain effective. By treating every fall as a learning experience, aged care facilities can continuously enhance their fall prevention protocols and ensure the highest standard of resident safety.

For additional resources on developing and managing fall prevention programs, visit the Agency for Healthcare Research and Quality at https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man2.html.

Conclusion

Effectively managing a resident fall in aged care is a multi-step process that extends beyond the immediate incident. It involves rapid assessment, a structured medical response, a thorough investigation, and the implementation of proactive prevention measures. By following a clear protocol, documenting every detail, and fostering open communication with families, care providers can ensure resident safety and reduce the risk of future falls.

Frequently Asked Questions

What is the very first step to take after a resident falls?

The very first step is to assess the scene for danger and the resident for injury. You should never immediately move the resident, as this could worsen a potential injury, especially to the head, neck, or hips. Call for assistance immediately and provide reassurance from a safe position.

When should I call emergency services for a resident fall?

You should call emergency services immediately if the resident is unconscious, bleeding heavily, reports severe pain (especially in the head, neck, or back), has an obvious fracture, or if their breathing or consciousness changes. Always follow your facility's specific emergency protocols.

How should I document a resident fall?

Documentation should include a detailed incident report. Record the date, time, and location of the fall, what the resident was doing beforehand, the apparent cause, the injuries observed, the full staff response, and any subsequent actions taken. This information is crucial for future prevention.

What information should I provide to the resident's family after a fall?

You should provide factual, timely, and empathetic communication. Inform them of the fall, the immediate medical actions taken, the resident's current condition, and the next steps in their care plan. Ensure they have an opportunity to ask questions and are kept informed of the investigation's outcome.

What happens during the post-fall investigation?

The post-fall investigation involves gathering information from witnesses, the resident, and reviewing the environmental factors. The goal is to determine the cause of the fall and identify any modifiable risk factors. This is a critical step for preventing future incidents.

What are common causes of falls in aged care residents?

Common causes include muscle weakness, medication side effects, poor balance, environmental hazards like clutter or wet floors, and vision problems. A post-fall assessment will help pinpoint the specific cause for that resident.

Why is a care plan review necessary after a fall?

Reviewing and updating the care plan is essential to implement new strategies that mitigate the specific risks identified during the investigation. This can include changes to medication, mobility support, or environmental adjustments, and helps to individualize the prevention efforts.