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Fall Prevention in the Nursing Home

A fall can lead to death in older adults.

A fall can lead to death in older adults. According to the CDC, older adults experience a fall incident every second, making falls the leading cause of death in the United States.

As a nurse, you have the dreaded task of calling family members following a fall, and it is a tough one! I have made more of these calls than I care to admit, but it always made me think about what could have been done to prevent this fall from occurring. My DNP project focused on falls in the nursing home.

The PICOT-problem, intervention, comparison, outcome, and time (PICOT) question was based on the DNP project: For the residents at my local long-term care facility, does the implementation of the AHRQ falls management program, compared to current practice, reduce the number of residents falls and recurrent falls in ten-weeks? This post will help you delve into why residents falls and how you can help prevent a subsequent fall.

Why did the fall occur?

The first question the family member asks you is: why did their family member fall? This dreaded question is answered with diagnostic information and compassion for the family member. This is a part of the disease trajectory of the resident's dementia. This is a correct answer most residents in the nursing home who fall have some form of cognitive impairment that can cause them to fall more frequently.

There are many other reasons falls occur so frequently in the nursing home some of the causes are modifiable, and some are not. Easy adjustments staff can make to prevent a fall include decluttering their resident's environment, assessing footwear, and scheduling vision checks. Other adjustable causes of falls include female gender, psychiatric medication use in the elderly and polypharmacy. Other reasons residents fall are not adjustable, including dementia, disabilities, and old age.

How can you prevent another fall?

BUT the family member says, how can you prevent the fall from reoccurring? Falls have multiple causes. Therefore, fall prevention and interventions must be multifactorial and tailored to the person who falls, such as the Agency for Healthcare Research and Quality falls management program. There are many different policies and procedures used in nursing homes to prevent falls. I prefer the AHRQ's because it implores the staff to take a closer look at the fall occurrence and treat it with an interdisciplinary team approach to prevent subsequent falls.

This quality improvement project begins with recognizing falls as a problem in your facility then taking calculated steps to prevent the next fall. If you follow the diagram following each fall, it can usually lead your team to victory, and falls will slowly be a thing of the past in your facility.

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