Nursing Home Falls: Fixing Systemic Risks
Are nursing home falls really just “accidents,” or signs of a deeper problem? Many falls are the result of poor planning, understaffing, or missed warning signs. These systemic issues put residents at constant risk. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Brianna de Oro to talk about what causes nursing home falls and how facilities can—and should—do more to prevent them.
de Oro:
As you walk around the facility, look at certain things and be like, as we’re walking around, if you see this rug, this is a trip hazard and observations as you’re educating. Just like all staff meetings, most nursing homes have all staff meetings usually once a month where everybody comes in. So I think that’s another opportunity just for ongoing education too.
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. Today we’re talking from a systemic standpoint, from a facility-wide standpoint, prevention of falls, but we’re not doing that alone. We have the fantastic Brianna de Oro on the show today to walk us through that process.
Brianna is a seasoned nursing professional specializing in medical surgical care, long-term care, wound care, and healthcare litigation. She holds a master’s and nursing leadership and is a certified legal nurse, consultant and board certified wound care nurse. As Director of clinical services at Foundation Healthcare Services and owner of Lakeview Legal Nurse Consulting, LLC, Brianna offers expert case analysis and litigation support and long-term care and healthcare legal matters.
Learn more about professional consulting services by visiting Lakeview Legal Nurse Consulting, LLC on LinkedIn.
Lakeview is where I went to elementary school, Lakeview Elementary School in Mountain Juliet, Tennessee. Anyway, sorry. Sorry about that, Brianna. Anyway, Brianna. Welcome to the show.
de Oro:
Hi. Thank you.
Schenk:
We have had several episodes that deal with here are some interventions if the person’s at a fall risk or here are five ways to prevent a fall, like in, in a certain specific instance.
What are broader facility policies that can help prevent falls?
Schenk:
Okay. I haven’t had a more systemic prevention of falls episode for nursing homes. So I’m glad that you’re on to help us with this. So I guess. The opening question would be this: what are some of the more broader policies that nursing homes can put into place that would prevent falls just from a general standpoint.
de Oro:
Yeah, so I think when it comes down to fall management facilities sometimes are too generic and too broad in their fall prevention policies. So we’re bound by state and federal regulations, and that’s pretty much it. We can go above and beyond if we want to, but facilities and companies as a whole kind of stay away from doing that so that they don’t get in trouble for not following their own policy. I like things a little bit more specific. That’s just me. I think the policy should mention what fall risk assessment tool we’re going to use and how frequently we’re going to use it, and then based upon that score. We should have something implemented like fall risk bundles.
So if someone’s at a low fall risk, then these are maybe the things that we’re going to do for that patient. It could be things like, call it within reach adequate lighting. Those are pretty standard things, right? But then if you have someone who scores high risk, then maybe they’re placed into a fall prevention program where we monitor them weekly and their care plan’s gonna be more individualized.
Again, I think facilities stay away from doing protocols like that, but that would really help us on the front line getting ahead of falls and preventing them, in my opinion.
This recent study provides key findings on the impact of preventive health measures in elderly populations.
Schenk:
That’s so interesting that you say that. So I feel like sometimes where at least in, in my cases, and I’m not a nurse.
Like I’m not somebody doing the day out, day in, day out, like what, like you are. So but where I see some of the problems is where. There’s, you’re relying exclusively on your nurse judgment in this specific moment on a resident that you might not know very well. So when you say to me like, Rob, if you have a policy that says if you are this number, if you are this risk level, whatever here are automatic interventions that need to go into place, that takes that, that out of the ball game of people flipping through the cracks based on just the nurse’s judgment in that moment, et cetera.
Here are the things that you have to do. If the number is this, you can do more, but here’s the minimum. Does that make sense?
de Oro:
It does. And I think that you’re exactly right. We are missing that. A lot of nurses that do the fault risk assessments are not super familiar with the care planning piece of it, and they might not know what’s a good intervention and what’s a not so good intervention.
So by having just even a few examples, like these are the things, like you said, the bare minimum we’re going to do, at least there’s something in there right away.
Explore the role of patient-centered strategies on the impact of preventive health measures in elderly populations.
What does increased staffing do to help prevent falls?
Schenk:
Talk to me about the amount of staff on a shift at a particular time and how that potentially could lower the risk of falls.
Because a lot of times, like at least in, I feel like in the public’s mind, it’s who cares if there’s a hundred people there? If somebody’s gonna fall, they’re gonna fall. So how does that affect the likelihood that somebody would fall?
de Oro:
Residents have the right to fall, right?
And we’re not gonna be able to catch them or prevent them all of the time. But when you have more staff, you have more eyes on the residents, like that’s just how that goes. You have more staff available to maybe see if there’s a change in condition, right? Like maybe someone’s having more confusion and you can go in and mitigate a fall risk because you have more.
Staff on board, able to spend more one-on-one time with those patients. You have more staff available to help with transfers, answering call lights, walking them to dining just more hands on deck to help patients.
Older studies still offer relevant insight on the impact of preventive health measures in elderly populations.
How can nursing homes address environmental risks for falls?
Schenk:
That, that makes a lot of sense. If you have more hands on deck, there’s more eyes than the people and stuff like that.
Even if it’s not one-on-one or one-to-one care, it’s still, you’re seeing if somebody’s off baseline and things like that. What about the. W things that the nursing home can do on a broad level in terms of the environment. What are, like, make sure the lights are bright, things like that.
de Oro:
I think the easiest way to determine and to mitigate environmental hazards is to do environmental rounds. Like we’re really good at rounding in the facility to check on our patients, right? But when do we, do scheduled rounds to go look at the environment? Is the floor wet? If it’s wet, is there a wet floor sign up?
Do we have adequate lighting in the room? Do we have trip hazards like rugs that shouldn’t be there? Just doing that schedule and maybe even having a worksheet on areas that you’re looking at environmentally. And then I think a big thing that we miss too is educating all of our staff on the environment.
This ACP Journal article emphasizes physician responsibility on the impact of preventive health measures in elderly populations.
So starting with new hires, what types of fall risk are there in our environment? And incorporating a culture of safety is huge. It’s not just nursing, it’s not just therapy, it’s not just administration, it’s everybody in the facility. Being able to identify what a potential risk could be and what they could do about it.
For a comprehensive overview, check out Fall Risk Assessments and Prevention in Nursing Homes.
Schenk:
So that’s interesting. So it’s an environmental round, like in your experience, like what would be best practices for how often that should be occurring?
de Oro:
I think your maintenance director probably does environmental rounds all of the time when they’re going around the facility. But I would say at least weekly where you have like your administrator, your DON and maintenance, just doing the whole thing inside and outside.
If you have courtyards where therapy takes patients to walk on the curb and the concrete, is there trip hazards out there? Is it cracked? Do we need to fix it? All that kind of stuff. So I would say at least weekly.
Read further analysis of ethical practices on the impact of preventive health measures in elderly populations.
What role does staff training play in fall prevention?
Schenk:
And then you mentioned that staff training is important. Is this typically by way of in-service or is it like, hey, everybody’s gonna have to follow around, miss Nancy because she’s the best at, transfers and hasn’t dropped somebody since 1978.
Like how does that work? What are you envisioning when you say staff training?
de Oro:
I think of the onboarding orientation process where you have everybody come in a room, doesn’t matter what department they’re in, and usually you have maintenance come in and talk about let’s go on a tour.
These are where we have, the fire alarms and the doors and this, the, i’m totally blanking on the fire extinguishers. That’s important. We have to know where those are. But I think in that moment you could really, as you walk around the facility, look at certain things and be like, as we’re walking around, if you see this rug, this is a trip hazard and observations as you’re educating.
Learn your rights and options through our Georgia nursing home falls attorney resource page.
And then I think going forward it would be just like all staff meetings, most nursing homes have all staff meetings usually once a month where everybody comes in and it’s verbal education. So I think that’s another opportunity just for ongoing education too.
Dive deeper into clinical solutions in Episode 131: Interventions for Fall Risk Prevention in Nursing Homes.
Schenk:
What role does QI play in fall prevention from a broad perspective?
In other words, like what does a nursing home need to be doing in terms of looking at data to revise policies, et cetera?
de Oro:
Yeah, so I think when you have a coffee meeting, it’s important to look at all of the incidents that we have in the facility, but specifically related to falls. Is there an increase this month than we had last month?
And then tracking and trending, is it a certain shift? Is it always on your no shift where you have more falls? Is it on the weekends? And then looking even more so into, is it staffing, is it like a particular staff person where their people fall more and they maybe need some more training?
Find out the legal requirements and responsibilities of care facilities in our article on whether Georgia nursing homes are required to prevent all falls.
So I think tracking and trending it in quai is very important. And then if you identify trends, putting on a performance improvement plan, we’ve identified this, we’re gonna reeducate it, and then we’re gonna follow it and monitor it going forward.
Schenk:
That’s interesting. So I guess what would be the minimum data that you would want to get from a fall so that you could use it in the aggregate, in a PY meeting?
In other words like, you fall from bed versus, f fall over here, or ex et cetera. You see what I’m saying? What are you, what are you needing in order to do your job of making the policies better?
de Oro:
I think the very bare minimum would be the amount of saws that you have.
What shifts that would be like the bear just to figure out is it a day shift, not shift weekends or whatever. And then going forward, you brought up a good thing that I’ve actually never thought of. I’ve never thought to track like, is it fall out of bed versus fall in the bathroom? But you could really look at that if you’re trying to drill down, if you’re identifying some issue.
That’s another way that you could drill into it.
If your loved one died due to a fall, see if you may have a case by reviewing this guide on wrongful death after a nursing home fall.
Schenk:
Yeah, I feel like I, I guess the technology with the EMR systems, like you’re gonna be able to run more and more specific reports and be able to really hone in on that data. So typically you mentioned that, you have.
How do you identify and manage high-risk patients for falls?
Schenk:
Every facility would assess fall risk. And there are different types of assessments. They all have their different names and such. But in general, what are you looking for? What are the major components that are gonna put somebody at a risk of fall versus another?
de Oro:
History of falls, that’s a big one. Age, I think it’s usually, typically anything over 65 puts you at increased risk just because of age. Medications. Medications that can cause dizziness, that’s a big one. Blood pressure medications sometimes, and then you have diagnoses. Certain diagnoses just increased your risk of falls. Those are the main components that I can think of right now that are on a fall risk assessment.
Learn how falls in long-term care facilities may lead to lifelong consequences on our permanent disability claims page.
How can regular fall risk assessments improve prevention efforts?
Schenk:
I see. And typically, like how often are you once you’ve flagged somebody as being a high fall risk? Like how often are you reevaluating their fall risk or their and their interventions?
de Oro:
Yeah, so you would redo the fall risk. I think just the minimum is upon admission and then you do it quarterly after any fall.
So if someone suffers a fall, you’re gonna do another as risk assessment to see if they’ve scored differently. And then, change in condition.
Understand how facilities can be held accountable in Episode 42: How Nursing Homes Can Be Liable for Injuries from Falls.
Where do nursing homes typically fail in preventing falls?
Schenk:
I see. In your experience, Brianna, where are you seeing nursing home facilities dropping the ball in terms of risk? Fall prevention.
de Oro:
Yeah. Honestly, I think facilities don’t do a good enough job at investigating why a resident fell. And if you don’t do a good investigation, then your interventions to mitigate risk going forward are not going to be good. For example, I’ve seen where a resident fell out of bed and an intervention was related to a wheelchair, which.
That might be a great intervention for the wheelchair, but it doesn’t get to the root cause of why that patient fell. So just educating our staff on what’s required. When we do have a fall, we want to look at the scene and check out things like, is the floor wet? What did the residents say they were doing?
Is the lights on? There’s just a whole bunch of questions that we should be asking and then making sure that the nurse is getting statements from staff and then filling out a good incident report. ’cause the more information the facility has on what happened, then the better the interventions are going to be.
Explore best practices in Episode 86: Caring for Nursing Home Residents at Risk of Falls.
Schenk:
That’s so interesting that you say that because I run into the inverse when I am investigating cases. Like I’ll have a nurse say, Rob. This fall, there’s an injury with the fall and they didn’t plan for X. And when I say what have, would x have prevented that fall? The nurse says, oh I guess not.
And it’s you know what? I’m not sure if that’s the case then we have to make sure that we’re not holding the nursing home accountable for. Some future injury. It’s the injury that, that, that occurred, right? So maybe there’s probably some attorneys that are screaming at me right now, but that’s how I look at it, is the, as you mentioned the idea here is if the person fell, you want to try to prevent that type of fall in the future, right?
So you’re looking at interventions that are specific to that. So I get that. 100%.
de Oro:
Yeah, especially when it comes to, sorry. Yeah, just especially when it comes to residents with multiple falls. When I investigate fall cases as well, I look at, okay, so they had this one fall. What did they put in place after that fall and did it work to prevent another one?
And often they don’t do anything or it doesn’t make sense. Exactly.
Get proactive strategies in Episode 122: Five Ways to Prevent Falls in Nursing Homes.
Schenk:
Very well said. Brianna, thank you so much for coming on the show and sharing your knowledge with us.
de Oro:
Yes. Thank you for having me.
Schenk:
Folks, I hope that you found this episode educational. If you have an idea for someone that you would like for me to talk to, please let me know.
If you have an idea for a topic you would like for me to talk about, let me know that as well. Be sure to participate in the nursing home regulation question of the week by putting in your favorite nursing. I’m sorry, your favorite Dairy queen. Blizzard topping. It doesn’t have to be Heath. It can be the.
Butterfinger, I think that would be my second choice. The second choice would be Butterfinger. Best of luck to you to win the mug. New episodes of the Nursing Home Abuse Podcast come out every single Monday. And with that folks, we’ll see you next time.
Brianna de Oro’s Contact Information: