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I have worked in long-term care for the past three years. I have noticed since my time in long-term care that falls are a significant problem. In February 2018 my facility had 20 falls, none of which resulted in injury. In the past, some falls have resulted in injury and led to residents being admitted to the hospital. Thankfully, as of late no current falls have led to any injuries.
After speaking with the Director of Nursing, she stated that the facility has been struggling with preventing falls because there seems to be a break in communication between the interdisciplinary team (IDT) and the front line nursing staff once high-risk fallers are identified. The facility uses a fall risk assessment to identify residents at high risk for falls, but she has found that the information is not always communicated to the nurses and certified nursing assistants (CNA).
All falls are reported to the nurse managers, and an incident report is completed in the electronic database LTC. Weekly risk meetings are held for residents with multiple falls and are followed for four weeks. Unfortunately, the outcomes from the meeting are not made available to the nursing staff, which could help prevent future falls. The nurses also monitor the residents for 72 hours following all falls and must document each shift.
I also spoke with eight nurses on the day and evening shifts to find out if they believe falls are a problem in the facility and the steps they take to prevent them. The interviews with the nurses produced mixed responses. Some were unaware that so many falls occurred during the month of February. They were able to identify a few of the residents they felt were at a higher risk but were not aware of their latest fall risk scores. They also stated that through the busy workday that they are not always able to round as often as they would like on their patients that are at a higher risk, and rely heavily on the CNAs.
Falls are a significant threat to patient safety. During my interview with the Director of Nursing and the nurses, it was agreed that there needs to be more communication between the IDT and the nurses that work directly with the residents. This is important because falls place a significant financial burden on all those affected. The literature suggests having a set fall protocol in place, as well as hourly rounding by all staff to help reduce patient falls (Goldsack, Bergey, Mascioli, & Cunningham, 2015).
The hourly rounding also needs to be patient-centered and individually tailored to the population’s needs. Research also found that communication among healthcare team members also play an important role in reducing falls and that fall prevention is the responsibility of all staff (Avanecean, Calliste, Contreras, Lim, & Fitzpatrick, 2017).
References
Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006-3048. doi:10.11124/jbisrir-2016-003331
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: What factors boost success? Nursing, 25-30.