What to do when a patient falls in care home: A Comprehensive Guide

According to the Centers for Disease Control and Prevention (CDC), 50-75% of nursing home residents experience a fall each year. This statistic highlights the immense importance of having a clear protocol for what to do when a patient falls in care home to ensure safety, mitigate harm, and prevent future incidents.

Quick Summary

Immediate response and proper assessment are crucial when a resident falls. This guide outlines the essential steps for care home staff, covering injury evaluation, thorough documentation, and revising care plans to reduce future risks.

Key Points

• Immediate Safety Check: Upon discovering a fallen patient, first ensure the scene is safe, then assess the patient's condition without moving them, and call for emergency help if necessary.

• Thorough Documentation: Accurately complete an incident report detailing the date, time, location, circumstances of the fall, and the staff's response, regardless of injury severity.

• Comprehensive Assessment: After the initial response, conduct a deeper investigation into the fall's cause, considering environmental factors, patient activity, and potential medical issues.

• Care Plan Revision: Promptly review and update the patient's care plan, ideally within 72 hours, to include new interventions and prevention strategies based on the fall investigation.

• Proactive Prevention: Implement long-term fall prevention measures, including staff training, environmental hazard removal, and using appropriate assistive technologies, to minimize future risks.

• Regular Communication: Maintain clear and consistent communication with the patient, their family, and all relevant staff about the fall and ongoing prevention strategies.

Falls in a care home setting are a serious and common occurrence, demanding a systematic and compassionate response. The correct actions taken immediately after a fall, and in the days that follow, can significantly impact a patient's recovery and the facility's overall safety and liability.

The Immediate Post-Fall Response (First 15 Minutes)

The moments immediately following a fall are critical. Staying calm and following a predefined protocol is essential to ensure the patient's safety and well-being.

Assess the Scene and the Patient

1. Ensure safety: Before approaching, quickly scan the area for any immediate dangers, such as spilt liquids or loose electrical cords, that could pose a risk to you or the patient. If the area is unsafe, secure it first.
2. Encourage stillness: Gently instruct the patient not to move. This is especially important if they are complaining of pain, particularly in their head, neck, or back. Moving a patient with a spinal injury could cause permanent damage.
3. Check for consciousness and breathing: If the patient is unresponsive, call for emergency medical services (911/999) immediately. If they are not breathing, begin CPR if you are trained to do so.
4. Perform a visual assessment: Look for any visible injuries, such as cuts, bruises, swelling, or deformities. Pay close attention to areas most vulnerable during a fall, like hips, wrists, and ankles. Also, note any distress or confusion.

Call for Help and Provide Comfort

1. Summon a colleague: Use the call system or verbalize a clear request for a second staff member to assist. This ensures you have support for moving the patient and managing the situation.
2. Summon emergency services if required: If the patient is seriously injured, disoriented, or if a head injury is suspected (especially if they are on blood thinners), call emergency services. Always err on the side of caution. Even if the patient seems fine, a doctor's check is vital if there are 'red flags'.
3. Keep the patient warm and comfortable: While waiting for help, cover the patient with a blanket and provide reassurance. A small pillow under the head can increase comfort, but only if there is no risk of a head or neck injury.

The Post-Fall Investigation and Documentation

Once the patient's immediate safety is secured, a thorough investigation and reporting process must begin. Federal and state regulations often require falls to be reported, especially if an injury occurs.

Conduct a Post-Fall Assessment

This assessment gathers all necessary information to understand what led to the fall. Even if the fall was unwitnessed, staff expertise can provide valuable insights by examining the scene.

Data to collect immediately:

• Date, time, and precise location of the fall.
• Resident's reported or observed activity at the time of the fall.
• Details of any witnesses (staff, other residents, visitors).
• Environmental factors, such as spills, clutter, or faulty equipment.

Complete the Incident Report

Every fall, whether witnessed or unwitnessed, with or without injury, requires a formal incident report. The report must be completed accurately and in a timely manner. Key details to include are:

• Circumstances: A detailed, non-judgmental description of the event.
• Staff Response: The sequence of actions taken, including who responded, when, and what was done.
• Resident Outcome: Any injuries sustained, initial vital signs, and how the patient was moved or assessed.
• Notifications: Document all communications with supervisors, the patient's physician, and family members, including times and dates.

The Long-Term Management and Prevention Strategy

The fall response does not end with the incident report. A comprehensive review and updated care plan are crucial for preventing reoccurrence.

Review the Care Plan

Within 72 hours of a fall, the interdisciplinary team must review and revise the patient's care plan. The review should incorporate new information from the fall investigation and re-assess risk factors. This is an opportunity for targeted intervention, which could include:

• Adjusting medication schedules.
• Increasing assistance during high-risk times (e.g., toileting).
• Providing more appropriate footwear.
• Engaging physiotherapy for strength and balance training.

Staff Training and Communication

Ongoing training is vital for an effective fall prevention program. Staff must be educated on fall risk factors, proper response protocols, and how to identify subtle changes in a patient's condition that could signal an increased fall risk. Effective communication ensures all team members are aware of changes to the care plan.

Environmental Modifications

Regular environmental-of-care rounds can identify and eliminate extrinsic risks.

Common environmental hazards and fixes:

• Poor lighting: Use brighter bulbs and nightlights.
• Slippery floors: Ensure quick cleanup of spills and use non-slip mats.
• Clutter: Keep pathways clear of personal items and equipment.
• Inappropriate furniture: Ensure chairs and beds are at a safe height and have secure brakes.

Fall Detection and Prevention Technology Comparison

Care homes can supplement staff vigilance with various technologies. Here is a comparison of different options:

Feature	Bed/Chair Alarms	Wearable Fall Detectors	Bedside Fall Mats	Real-Time Location Systems (RTLS)
Mechanism	Pressure-sensitive pad triggers an alarm when patient gets up.	Accelerometer detects sudden, fall-like motion and alerts staff.	Padded mat provides cushioning and can be linked to an alarm system.	Tracks resident movement and location, alerting staff to unusual behavior.
Pros	Affordable, direct alert when movement begins.	Mobile, works anywhere on the premises. Some offer automatic alerts.	Prevents injury by cushioning the impact, and can be integrated with alarms.	High accuracy, offers broad oversight for residents at risk of wandering.
Cons	Prone to false alarms, only effective when used. Can startle and agitate patients.	May not detect all falls, can be inaccurate if not worn correctly. Battery life concerns.	Can create its own trip hazard if not managed correctly. Limited to bedside area.	Potentially invasive, requires significant infrastructure investment.
Best for	Patients requiring reminder not to get up unassisted.	Residents with higher mobility who want independence.	Patients with highest fall risk, especially from bed.	Facilities with dementia patients or complex fall risk profiles.

Conclusion

Responding to a patient fall in a care home is a multi-step process that extends far beyond the immediate moments after the incident. A swift, compassionate, and standardized immediate response is paramount. This must be followed by a meticulous investigation, comprehensive documentation, and a thorough review of the patient's care plan. By continually assessing and mitigating fall risks through environmental changes, staff training, and leveraging appropriate technology, care homes can create a safer environment and reduce the frequency and severity of patient falls. This proactive approach not only protects residents but also improves overall quality of care and minimizes liability.

Further information on establishing a falls management program can be found at the Agency for Healthcare Research and Quality.

Frequently Asked Questions

What is the first step when a staff member finds a patient on the floor?

The first step is to stay calm and assess the situation from a safe distance. Encourage the patient not to move, and check for consciousness and breathing. Call for help from another staff member and, if the patient is unresponsive or seriously injured, contact emergency medical services immediately.

When should emergency medical services be called after a patient fall?

Emergency services should be called immediately if the patient is unconscious, unresponsive, bleeding excessively, complaining of severe pain (especially head, neck, or back), or shows signs of a head injury like confusion or dizziness. Always err on the side of caution.

Should a patient be moved immediately after a fall?

No, a patient should not be moved immediately. Moving them could worsen a potential injury, especially if a spinal or neck injury is suspected. Only trained professionals should move a patient, and only after a thorough assessment confirms it's safe.

What information should be included in a fall incident report?

An incident report should include the date, time, and location of the fall, the circumstances leading up to it, a description of the fall, any injuries sustained, the response of staff, and any witnesses. All notifications to physicians and family members must also be logged.

How soon must a patient's care plan be updated after a fall?

A patient's care plan must be reviewed and revised within 72 hours of any fall incident. This ensures that new prevention strategies and interventions are put in place quickly to prevent further falls.

Are care homes legally obligated to report falls?

Yes, care homes are legally required to document and report certain falls. The Centers for Medicare and Medicaid Services (CMS) mandates reporting for falls resulting in serious injury, with reports for such incidents often required within 24 hours.

What is the importance of family communication after a fall?

Transparent communication with a patient's family is crucial for building trust and ensuring they are involved in care decisions. Care homes are obligated to inform families of significant incidents, including falls, in a timely manner.