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Risk Management: Clinical Areas of Liability - Falls

One of the most common risk management concerns for nursing facilities is falls and fall-related injuries to LTC residents. Reports indicate the incidence of falls in nursing homes is 1.6 falls per bed per year. Additionally, fall-related injuries can lead to major disability and even death.

Although some falls result from negligence, injurious falls can occur even when every effort is made to ensure the safety of residents. Some of the complications from falls are avoidable with good care. However, others are unavoidable. When lawsuits are filed, an injurious fall is frequently blamed on the negligence of the facility and complications resulting from the event are cited as evidence of neglect.

At this point, care plans and physical therapy notes become evidence of appropriate care. Written orders, assessments, care plans, and application and monitoring of care must be thorough. Additionally, any deviations in care plans or physician orders must be well documented.

There are some specific steps facilities and caregivers can take to minimize exposure from fall-related injuries.

  • Assess new admissions for fall risk
  • Maintain a fall prevention program
  • Individualize care plans for residents identified as high-risk
  • Update assessments and care plans for residents who fall or have a change in medical condition
  • Educate residents, family, and staff concerning fall prevention
  • An interdisciplinary approach for a safe environment within the facility
  • Prompt assessment of fall incidents by appropriate medical personnel
  • Immediate generation of fall incident reports
  • Interventions as needed to prevent future falls

Physical restraints do not prevent falls or injuries, nor do they enhance patient safety. Additionally, they unnecessarily inhibit function and psychosocial well-being. When physical restraints are used, there must be informed consent, a physician’s order, and continual reassessment of use. Notes must document the reason for restraint, toileting times, ambulation frequency, and release times. The care plan must also include evaluations considering the reduction or discontinuation of restraints.

If a fall results in litigation, attorneys frequently attribute injurious falls to lack of physical restraint. However, physical restraint use in the nursing homes is highly regulated. These regulations provide a yardstick against which a facility’s care is measured. All staff members should be educated concerning federal and state regulations governing the restraints. Training should be given to new employees prior to caring for individuals with restraints. Documentation of all such training must be maintained in a central file.

Some fall events are unavoidable even in the best of circumstances, but others are accompanied by such issues as untrained staff or poor quality of care. Risk management and quality care must be a highly visible aspect of a nursing facility’s operations.

At Highland Risk, we continue to help your cleints at senior living facilities improve the quality of life for their residents. We provide timely information and services for continuing care retirement communities, independent and assisted living facilities, and nursing homes. We are available to serve our agents at our Chicago office at 847-8342-9100 or our Lansing office at 517-676-7100.

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