When it comes to documenting infections, falls and other adverse events, what you don't know can hurt you at survey time. "Between staff costs, investigation costs and possible litigation, it can be $9,000-12,000 every time there's a fall," said Mary Jann, RN, BA, director of regulatory affairs, California Association of Health Facilities, during an educational session at the 2013 American Health Care Association/National Center for Assisted Living conference.
Training staff in proper protocols to reduce falls goes a long way, but training them to gather crucial information when something goes wrong is just as important. Following a fall, for example, the charge nurse should serve as the quarterback in the huddle, organizing the collection of data to map out the scenario leading up to the fall, Jann said.
"Literally re-enact the fall," she suggested. "What was the resident doing right before the fall? Where did the fall take place? Was anything different about the resident's demeanor or routine today?" This type of "fall scene investigation" helps to decipher the causes of the fall and creates a record of information that is valuable for establishing due diligence for both legal cases and surveys, she added.
Location holds plenty of clues, especially within the resident's own room. Falls that occur at the bedside may indicate an orthopedic issue. Falls within 15 feet of the bed may the result of a balance or gait problem. Disorientation may contribute to falls occurring further away from furniture.
Pay special attention to falls that take place in the bathroom, examining the floor carefully for spilled water or other items that may have tripped the resident. "When a fall occurs in the bathroom, look in the toilet," Jann said, adding that stool may reveal signs of constipation, while urine on the floor may indicate disorientation.
All facilities should conduct regular risk assessments and monitor new residents carefully for the first few days after admission. It's also wise to implement 72-hour charting for a resident who has fallen. Above all, Jann said, "revise the care plan after any fall."