Falls occur commonly in skilled nursing facilities, or nursing homes, as well as in the community. A global report from the World Health Organization on falls indicated: “The frequency of falls increases with age and frailty level. Older people who are living in nursing homes fall more often than those who are living in the community. Approximately 30-50% of people living in long term care institutions fall each year, and 40% of them experienced recurrent falls.”
While not all falls are preventable, planning for falls is an essential function of nursing practice. The nursing care-planning process uses the scientific method: Plan-Do-Study-Act. In the “Plan” stage, a nurse identifies the resident’s actual or potential risk(s)–patient safety, infection control, nutritional, etc.–then visualizes an intervention for each actual or potential risk that when implemented neutralizes, or reduces the risk. The nurse documents. The nurse enters the “Do,” or the stage when implementing the care plan and when monitoring the patient’s outcome from the intervention. The nurse documents. After time passes allowing enough outcome data to generate, the nurse studies the original plan and measures its effectiveness against the outcomes. The nurse documents. Lastly, the nurse tailors the plan (if indicated) to allow the patient, or resident, the opportunity to achieve the safest, best outcome. The nurse always documents.
Nurses must be affirmatively in charge of the patient’s medical and nursing plan of care. Nursing education and training, as well as each state’s scope of practice requirements place the duty to monitor and revise an implemented nursing care plan solely in the hands of nursing. This a great authority which nurses should embrace with confidence and courage. To engage our senses and skilled acumen, and record our expert thoughts and impressions. Should a patient falls in a facility five times over five months, without the facility implementing any new intervention(s) after each fall, concern should center on the facility’s delivery of nursing services. A patient who falls five times over five months should have her care plan reviewed after every fall and should receive new interventions to minimize the risk of falling during each review.
A facility’s administration must develop regular, dependable systems to help nurses stay on top of falls in their facility. Nursing homes can convene committee(s) to manage, report, and take action to improve fall rates, in part with quality improvement projects in the organization. With teamwork and shared concern, nursing homes can develop strong systems of fall safety. The use of trained, dedicated, one-to-one supervision should not always be ruled out.
