Forming a falls prevention team: one facility's simplified approach to fall reduction.

As many as 60% of nursing home residents experience a fall at some point during their institutionalization. Studies show that developing and using a Falls Prevention Committee will result in a decline in fall incidence. This committee should identify and address potential fall risk factors, which can be extrinsic (environmental) and/or intrinsic (clinical).

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A multidisciplinary committee profile is recommended. It can include but not be limited to representatives of nursing (including aides), rehab, activities, maintenance, central supply, dietary, and pharmacy. Once a specific risk factor has been identified, appropriate team members can take steps toward intervention.

Every new resident should, on admission, be reviewed and evaluated for fall risk factors. New admissions usually have some degree of comorbidities that might be identified as fall risk factors. These intrinsic fall risk factors can include, but are not limited to, taking more than five medications, being more than 65 years of age, using psychotropic drugs, having a neurological disorder; using an assistive device, and having visual deficits, diabetes, and/or amputations. Healthcare institutions often categorize patients/residents as high, medium, or low fall risk, but addressing the specific risk factors rather than categorization of risk is optimal. At times the risk may have more to do with environmental conditions than the resident's clinical status.

For example: A 72-year-old male with no premorbid conditions trips and falls over a wheelchair legrest. Should he be categorized as a high-risk faller? Not necessarily. The factor that challenged his balance was the legrest and, once it was moved out of the way of traffic, his risk was reduced.

It is important for the team to review all fall-related incident reports, and these should correspond to nursing chart documentation. Documentation detailing the fall incident's location, time, position found, and area of injury (if any) are important. Upon any fall, an initial action plan should include a physical assessment (and, if indicated, a neurological assessment), vital signs, and blood sugar. The physician, DON, and family member/guardian should be contacted.

Most falls appear to occur in the late afternoon, in the evening, and on weekends. Therefore, we conclude that contributing factors can include fewer activities, less staffing, and fewer supervisors on the premises during those times. For this reason, Monday may be the best day to meet and quickly address any new fall incidents. It may be beneficial to personally tour the site of the fall to get a better perspective on the probable cause. Studies indicate that most residents in healthcare institutions fall in or en route to the bathroom. Interventions to reduce risk in this situation can include frequent bathroom rounds, the presence of a bedside commode/urinal, ensuring that the bedroom can beviewed from the nursing station, lab testing for possible UTI, and reviewing whether residents are on diuretics, which cause urgency and increased frequency.

The Falls Prevention Committee serves as an investigator of factors such as these. The team should designate a member to document findings, recommendations, and interventions, which should be reflected in nursing care plans. Unfortunately, some residents will fall no matter how often risk factors are addressed. Injury risk reduction methods such as hip protectors, floor mats, helmets, and increased one-on-one supervision are also crucial to any falls-management program. The team should provide staff in-services (including a sign-in sheet for all those trained) on the application and use of preventive products, such as wheelchair cushions, body alarms, hip protectors, and so on. Batteries for body alarms and chair alarms should be changed and documented every month. Interventions should be immediate and appropriate to the risk factor identified.

The formation of a Falls Prevention Committee is an important first step to reducing falls. Documentation, compliance, and timely reviews overseen by a dedicated team will continue to reduce the incidence of falls and improve residents' quality of life.

Tom DiCarlo is Rehab Program Coordinator and Aegis Master Clinician at St. Matthew Center for Health, Park Ridge, Illinois. For further information, phone [phone] or visit www.stmatthewcenter.org. To send your comments to the author and editors, e-mail [e-mail].