Illinois Council on Long Term Care

Developing Successful Strategies for Preventing Falls II

Fall Prevention Strategies

There are a variety of strategies that nursing home professionals can utilize to prevent falls and promote resident safety. The following are some recommendations from Illinois Council homes:

Identify residents at high risk for falling, including those having poor vision, gait disturbances, weakness, cardiovascular disease, incontinence, and a history of falls.
Include specific measures in the care plan of high-risk residents to prevent falls.
Increase the sensitivity of the entire staff to the potential for accidents within and around the facility through ongoing education programs. Each employee must play a part in noticing, reporting, and reducing potential hazards.
Assess newly admitted residents for the presence of factors that increase their risk of falls, orient them to their environment, and observe them carefully during their first two weeks at the facility.
A current list of all residents in the facility's fall prevention program should be posted at each nurses' station. In addition, participating residents should wear colored identification bracelets. A star or dot may be placed on the outside door frame of the resident's room, above the bed, at the nurses' station call light area, on the spine of the medical chart, or on the nurse assistant worksheet.
Instruct residents on the proper use of the nurse call system, including when and how to call for assistance. Check that the nurse call systems are operational and accessible for all residents.
Encourage resident to wear their eyeglasses.
Teach safe transfer techniques from bed, chairs, toilet, and wheelchairs. Advise residents to change positions slowly, holding on to a stable object as they do.
Utilize exercise as a means of improving resident strength, balance, and coordination.
Utilize volunteers and family members to assist with monitoring.
Have the facility therapist evaluate residents for interventions such as physical therapy, restorative programs, and adaptive equipment such as positioning cushions or tilted seats.
Note and report changes in residents' physical and mental status promptly.
Monitor medications; in particular minimize the use of sedatives and tranquilizers.
Discontinue unnecessary medications.
Encourage residents to use handrails.
Residents at risk for falls should be placed in rooms near the nurse's station for easier observation.
Be sure that when residents need to be lifted, there is more than one staff member assisting. Even when using a Hoyer lift, two or even three staff members should be present. Make sure that safety straps are properly used.
A gait belt should be used whenever possible, especially when assisting a resident on or off a toilet seat in a cramped space. The shower is another source of major trouble, and residents should use safety straps while sitting in a shower chair.
Continuously assess for environmental hazards and eliminate as appropriate. Keep floors free from litter and clutter. Provide good lighting in all resident areas. Clean spills immediately. Maintain beds at their lowest position and keep bed wheels locked at all times. Use a low profile bed if needed.
Assure that residents use canes, walkers, and wheelchairs only when prescribed and that these aids are fitted to the individual and are used correctly. Make sure to check these mobility aids regularly to ensure they are in good repair, as broken equipment can cause injury.
Make sure that residents wear well-fitted, low-heeled shoes; prevent them from wearing long robes and pants that fall below the ankle.

Preventing falls is an issue for every staff member in the facility. Every department should be involved in developing strategies for fall prevention and in monitoring residents who are in danger of falling. Front-line staff members are a facility's best resource in developing practical interventions that are tailored to the unique needs of each individual resident.

Helping the Falling Resident

Staff members should receive training on what to do is they see a resident starting to fall. According to "Assisting with Ambulation" published by Long-Term Care Educator, it is important that staff learn the proper safety techniques, so that they don't cause injury to residents or themselves when trying to catch residents during falls. Techniques that can be helpful in easing residents to the floor to control falls are described below:

As soon as you observe that the resident is about to fall, spread your feet apart to establish a wide base of support and stabilize yourself.
Keeping your back straight, bring the resident as close to your body as possible. If the resident is wearing a gait belt, grab the belt. If the resident is not wearing a gait belt, wrap your arms around the resident's waist or under the resident's arms.
Position your leg behind the resident so that the resident's buttocks is against it.
Gently lower the resident to the floor, allowing the resident to slide along your leg. As the resident is sliding to the floor, lower your body by bending at the hips and knees.
Protect the resident's head during the fall.

Interventions for Activity Professionals

As a member of the interdisciplinary team, activity professionals play an integral part in the facility's fall prevention program. During the care planning process, activities should be part of the approaches for residents who are identified as "at risk for falls." It is important to share information about the identified residents with the rest of the activity staff so that each member of the team can do their part for the fall prevention program.

Activity professionals can incorporate specific practices and activities to lessen the resident's risk for falling. These include:

Lock the resident's wheelchair when engaged in an activity.
Position the resident where he/she can see and hear what is going on.
Make sure assistive devices such as walkers and canes are positioned close to the resident, but out of the way of other residents moving through the area.
Watch for signs that the resident has to use the bathroom and make sure he/she receives assistance or directions to the bathroom.
Place supplies, equipment, or props within easy reach.
Make sure the resident is at the proper height at the table to facilitate easy participation in the activity.
Provide organized walking groups.
Provide simple, strengthening exercises.
Keep supplies, and equipment "out of the way" of resident traffic.
Tape all cords, i.e., microphone and equipment, to the floor while in use until residents are safely out of the area -- try to keep these cords out of the "traffic pattern" until the last minute and then secure with duct tape.
Monitor resident's positioning and notify nursing to reposition resident as needed.
Work with rehab to learn the proper use of a gait belt.
After proper training, use gait belt to assist residents in walking group and other physical activities.
Remind residents to hold the rail for greater stability when walking.
Be alert for "spills" on the floor -- put up a "wet floor" sign and call housekeeping immediately or stay there while someone else calls housekeeping.
When gathering residents for an activity, be sure to leave an aisle for easy exit.
Position "restless" residents on the perimeter of the group so that they can leave and not feel "trapped."
Hold doors open for residents and make sure they are completely through the door before allowing it to close.
Remind resident to sit up to the table, lock his/her wheelchair, and release his/her "seatbelt" during the activity.
Remind residents with wheelchair "seatbelts" to secure them prior to leaving the activity.
Provide adapted sports, i.e., wheelchair bowling, wheelchair golf, wheelchair volleyball, wheelchair basketball, etc.
When doing a physical activity, such as parachute, make sure you have a group specifically for those who cannot stand and a group for those who can.
Incorporate aspects of Tai Chi into the activity program.
Utilize music to relax and calm agitated residents or to promote physical activity such as moving to the music.
Make sure the leader is visible, you cannot "lead" an activity if you are sitting down and blend "into the crowd."
Provide cognition activities for all cognitive levels -- more alertness means less tipping out of chairs.
Direct "lost" residents to their rooms or the area they are looking for.
Provide transportation for residents who tire easily -- suggest that they take a wheelchair "just in case."
Try to ascertain what is bothering a resident who begins to fidget -- do they need a sweater, is the glare bothering them, do they need to be toileted, are they too hot, do they need help completing the project, etc.
Hold/stabilize the resident's walker to assist resident to a standing position.

These are just a few of the ways activities can make a difference and help the residents remain active, independent, and confident with fewer falls.