Are You in Jeopardy?

June 18, 2019

By Karen Wilkinson,  RN, NHA, CLNC – CareerSmart® Learning Contributor


It’s time for Jeopardy!  While you may not be James Holzhauer, let’s see if your healthcare training and experience can help you in the category of “Accidents and Injuries.”  Here is the Jeopardy! answer:  Accounts for nearly one-third of all non-fatal injuries in the U.S.  Did you get the question?  Let’s try again with another answer: Causes the death of an older adult every 20 minutes.  The correct question for both answers is:  What is a fall?

The Centers for Disease Control and Prevention (CDC) provides us with statistics for older adults related to falls.  More than one in four older adults fall every year, but less than half will tell their physician about the fall.  And after an older adult has fallen one time, the chance of falling again is more than doubled.  Many older adults fear falling again and become less active and weaker.  Falls take their toll.  On a yearly basis, three million older adults are evaluated and treated in emergency departments for falls, and serious injuries such as fractures and head trauma occur in one out of every five falls.  Falls are also costly, causing 800,000 hospital admissions each year and costing $50 billion.  Even more tragic, 28,000 older adults, or 74 every day, died as a result of falls.

Because of injuries and deaths that occur as a result of falls, preventable falls are a source of liability to healthcare providers.  Good plaintiff attorneys understand the components of fall risk and assessment, fall prevention, and fall management and will use variances in standards of care to solidify their cases against providers.  For instance, let’s look at the area of fall management, or the sequence of events that follow a fall.  It is not uncommon to see that a nurse documented a fall and wrote, “no injury noted.”  However, nursing documentation should include results of a physical assessment as well as notation of any change in the resident‘s condition from before the fall.  For example, an expert witness will look for documentation of level of consciousness, range of motion, evidence of injury, and any complaint of pain.  Some additional areas of interest to a plaintiff attorney include the nurse’s determination that it was safe to move the resident and how the transfer was accomplished, documentation of timely physician notification that included the physician’s response, timely notification of the healthcare proxy/family, documentation that appropriate post-fall monitoring was completed, such as neurological checks according to facility policy, completion of a post-fall risk assessment, and care plan revisions with new fall prevention interventions. 

Most healthcare facilities have policies and procedures for fall assessment, prevention, and management, which should incorporate standards of care and provide “best practices” for the healthcare professional.  Additionally, many organizations and government agencies provide readily available fall prevention resources.  The Agency for Healthcare Research and Quality (AHRQ) has a toolkit for preventing falls in hospitals that focuses on “overcoming the challenges associated with developing, implementing, and sustaining a fall prevention program” as well as the “On-Time Falls Prevention” program for nursing homes that is “designed to help a multidisciplinary nursing home team prevent falls that can be avoided with good preventive care.”  CDC developed the STEADI Initiative for healthcare providers serving community-based older adults, which helps to identify risk for falls and modifiable risk factors and offers effective interventions in fall prevention.  The Joint Commission (TJC) and many regional, state, and federal healthcare quality and trade organizations also offer similar resources. 

The bottom line is that healthcare providers and care professionals must ensure responsible care that includes effective fall prevention.  You can choose to take a stand for fall prevention and stop the jeopardy of fall-related litigation.  Keeping our patients and residents safe also keeps us safe.

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4 Agency for Healthcare Research and Quality (2018). Preventing Falls in Hospitals. Retrieved June 17, 2019 from  https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html

5 Agency for Healthcare Research and Quality. (2018). AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention.  Retrieved June 17,2019 from https://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/fallspx/index.html

6 Centers for Disease Control and Prevention. (2019).  STEADI Initiative for Health Care Providers.  Retrieved June 17, 2019 from https://www.cdc.gov/steadi/index.html

June 26, 2019

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