This paper serves as an all-staff guide addressing the rising incidence of falls in nursing home settings. It identifies the major risk factors contributing to resident falls, including cognitive impairment, muscle weakness, medication side effects, and environmental hazards. The paper outlines evidence-based prevention strategies drawn from CDC guidelines, such as medication review, safety education for coherent residents, proper use of assistive devices, bed and chair alarms, and consistent staff rounding. It also emphasizes the importance of maintaining safe physical environments and stresses that fall prevention is a shared responsibility requiring coordinated teamwork among all nursing home staff.
There has been an increase in falls in nursing homes, and a number of factors can cause residents to fall. Illnesses such as dementia, among others, can cause residents to become confused. Confusion requires continual monitoring to keep residents safe. Muscle weakness and instability contribute to falls when residents are confused or when they insist on doing things themselves and maintaining their independence despite weakness or instability. Medications can also cause confusion; sedatives and anti-anxiety medications are a particular concern in this regard. Additionally, medications can cause drowsiness, which may lead to falls if residents are not placed in bed when those medications are administered.
Environmental factors also play a significant role in falls. Wet floors, poor lighting, incorrect bed height, improperly fitted shoes, poorly maintained wheelchairs, and items on the floor that create obstructions can all cause residents to fall. Poor foot care is another contributing factor when toenails, corns, and similar conditions are not properly addressed. Some shoe soles cause skidding on certain floor surfaces. Improper use of walking aids can likewise be a factor in fall incidents.
Residents should be required to wear non-skid sole shoes at all times. Wheelchairs should be well maintained with scheduled maintenance checks to ensure safety. All areas — including patient rooms where clothing, trash, and other items may accumulate on the floor — should be kept clean to prevent hazards. Spills of any kind should be cleaned up immediately.
According to the CDC's guidance on falls in nursing homes, nursing home staff have the ability to prevent falls when properly trained in fall prevention strategies. Risk factors should be addressed and underlying medical conditions should be treated. Reviewing prescribed medications can help determine when certain medications should be given with the patient already in bed. For residents who are coherent, safety education goes a long way in enabling them to practice safe behaviors at all times.
"Call lights, bed height, bedrails, and alarm devices"
"Continuous rounding to prevent falls and assist residents"
"All staff collectively responsible for resident safety"
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