Despite best intentions, falls regularly occur in long-term care settings due to residents’ age, health conditions and environmental hazards. While falls may seem inevitable in the difficult work of caring for our population’s frailest patients, most falls are entirely preventable.
In fact, research shows that while not all falls are preventable, they’re not inevitable. Between 20 and 30% of falls can be prevented by assessing risks and intervening to reduce them.
Falls prevention expert Leiba Millman, RN RAC-C, offers valuable training tips her team at Dynamic Reimbursement Services use to improve residents’ care and reduce falls –– while also improving Minimum Data Set (MDS) ratings and increasing reimbursement rates.
Preventing falls is a top-down priority that requires support at every level across your facility. Skilled nursing leaders should prioritize fall prevention as part of the day-to-day operations rather than just during compliance training sessions. Effective leaders also provide guidance and support, ensuring staff members have the necessary resources and training to prevent falls and improve quality measures.
Regularly discussing residents experiencing a decline in activities of daily living (ADL) scores in staff meetings and providing daily reminders keep fall prevention at the top of staff's minds. “We recommend clinical teams meet more often to discuss residents at full risk of falls. Most facilities do this monthly, but having it weekly or more frequently to discuss more interventions for at-risk residents is better,” says Millman.
Everyone on staff, from your nursing team to the housekeeping team, needs to be responsible for fall prevention. Training each team member on their role in keeping residents safe and cross-training them to support other roles can significantly reduce falls.
For example, housekeeping is typically trained to identify fall hazards quickly. Nursing staff are trained to recognize activities with an increased risk of falls, such as toilet transfers. Cross-training team members in these roles means housekeeping will know to get help when an at-risk resident needs the bathroom, and nursing staff feel responsible for eliminating housekeeping hazards like wet floors. Working together helps prevent more falls.
Takeaway: When fall prevention is a top focus for all team members, it fosters a culture where everyone feels responsible for improving quality measures and keeping patients safe.
Ways to prevent falls might seem obvious, but training often falls to the wayside when staff are overwhelmed. Staff need constant training and review for effective fall prevention.
For example, teach your staff the proper body mechanics for transferring residents appropriately so they’re squatting instead of using their backs to bend. Using better mechanics gives you more control of the residents while transferring them. “It’s a basic practice they teach in nursing school and CNA school, but we find it's something you need to really refresh the staff on,” says Millman.
Other training tips include the following:
• Initial staff training needs to be job-specific and facility-specific. Most importantly, training needs to be reviewed and revised frequently to stay on top of residents’ evolving care.
• Proper training should include ensuring staff members know how to recognize potential fall hazards and times of day when residents are most vulnerable.
• Continuing education training should emphasize how to safely transfer patients from one position to another, such as from bed to chair –– preventing injuries to both patients and staff.
Takeaway: Regular, relevant and engaging training sessions help to refresh skills and keep staff members sharp.
Senior nurses should add care plans to residents’ charts and then train junior caregivers on how to implement them. Make sure care plans are regularly updated, remaining an accurate source of truth is vital to successful fall prevention.
When falls do unfortunately occur, staff must be trained on how to document the incident accurately. When Millman and her team of nurses audit facilities, they often find evidence of inaccurate documentation that can affect quality measures. “Sometimes a patient didn't actually fall, or the fall was coded as a major injury when it was minor. Making sure to code falls accurately is a big deal that affects 5-star ratings,” says Millman.
Skilled nursing facility incentive payments were previously tied to hospital readmissions. Now, the reimbursement figures are more multifaceted in the value-based program.
Therefore, mistakes like inaccurate coding and documentation can be costly for the facility and confusing for the next shift. Therefore, it’s important to ensure that adequate training and support are in place to optimize staff accuracy in reporting to CMS.
Takeaway: Consider working with an MDS company that can audit and train your team to accurately assess patients to maximize Medicare and Medicaid reimbursement.
Cheap, old or broken equipment poses a significant fall risk. “You have to always be thinking of the next step for a resident prone to falling, like moving their wheelchair footrest out of the way when you know they’re likely to try to stand up at an activity,” says Millman.
• Train staff on proper equipment use. Durable medical equipment (DME) companies typically offer free training in-person or virtually to ensure staff are fully educated.
• All assistive devices, such as wheelchairs and walkers, should be properly maintained and regularly checked for wear and tear.
• Pay attention to bed railing positions to keep residents safe at night and assist in transfers. Beds designed for falls prevention, like Accora floor beds, can significantly reduce the number and severity of falls.
• Staff at all levels should be reminded to pay attention to equipment details, such as putting up or down a wheelchair footrest depending on the patients’ needs. It’s a simple adjustment that can cause or prevent fall rates.
• Staff should be encouraged to report any equipment issues promptly to ensure that residents have access to safe, functional tools for mobility.
Takeaway: Investing in quality equipment that lasts longer and is safer for residents is significantly less costly than fall incidents.
If your staff doesn’t know who is most at risk for falls and why, they can’t help prevent them. For example, if a resident is prone to wandering, it’s important that everyone is aware and can take proactive steps to prevent that resident from falling. Residents at full risk who need more support in activities of daily living, such as going to the bathroom, can be placed closer to the nurses' station.
“A lot of facilities do a full risk program where any resident at risk for falls has a sticker on their door and will wear special non-skid socks so all staff will know at a glance the residents who are at risk for falls,” says Millman. Opinions differ however, on the widsom of the blanket use of non-slip socks to prevent falls wihtout an individual assesment.
For long-term residents, staff should regularly evaluate whether their needs have changed and if they need mobility aids or personal assistance. “If the patient becomes more at risk for falls, the MDS nurse and the nursing team need to develop a care plan for how these residents can get more interventions to prevent falls,” says Millman.
Additionally, clear communication during shift changes ensures that all necessary information about residents is passed along, preventing gaps in care that could lead to falls.
Takeaway: Communicating about fall prevention for specific residents keeps staff focused on who needs fall prevention the most.
High turnover rates and the use of agency staff can impact the consistency of care, and ultimately, fall prevention efforts. Ensure your staff members feel supported and appreciated in order to reduce turnover and maintain quality care. “Nursing is a hard job, so keeping the staff happy by giving them incentives and paying them more goes a long way to improve staff retention,” says Millman.
A happy and motivated team is more likely to give their best to residents, including prioritizing fall prevention.
Takeaway: Simple acts of recognition as well as offering small incentives or bonuses go a long way toward fostering a positive work environment where staff are motivated to do the hard work of preventing falls.
Staff shortages and heavy workloads increase the likelihood of falls. When employees are stretched so thin that they don’t even have time for bathroom breaks, they can’t provide the level of attention it takes to prevent falls.
Staffing agencies can provide more hands on deck, but transitive care staff aren’t able to learn patients’ specific needs. Knowing who is at risk of falling and in what situation and time of day is key to preventing accidents.
Takeaway: Facilities must ensure adequate, consistent staffing levels to maintain safety.
Finally, says Millman, look to the data to find ways to improve resident care. “We look for trends like a specific shift, a set of rooms or certain residents in order to develop better fall prevention solutions such as adding more staff to a shift or switching residents’ rooms.”
Fall prevention is not just about having the right procedures in place. Your staff training, policies and team culture should be focused on preventing falls. Prioritizing fall prevention results in better outcomes for their residents –– and higher MDS ratings and reimbursement rates. “I see that those facilities with a solid nursing team and nursing leadership are consistently able to reduce falls,” says Millman.
By leading with intention, effectively training staff, and maintaining clear communication, long-term care facility staff can significantly reduce falls and provide the best possible care for residents.
Interested in accessing fall prevention training for you and your LTC team? Accora provides free fall prevention education through digital webinar events and other resources for healthcare professionals. You can always find our upcoming learning sessions on our website and to find out about our existing, on-demand resources, head to https://us.accora.care/resources.
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