2. INTRODUCTION
Falls in a long-term care facility is a very common problem.
Approximately 1800 residents will die as a result from a fall.
10-20% suffer a serious injury and 2-6% suffers a fracture.
Long-term care residents are twice as likely as an elderly individual living in
the community to suffer a fall. (CDC, 2012).
Falls are preventable!!

3. WHO’S AT RISK?
• Diagnosis of Parkinson’s, Dementia or Alzheimer’s.
• Poor vision.
• Decreased mobility and increased weakness.
• Residents with incontinence of bowel and bladder or both.
• Residents who have pain.
• Residents who take medications such as: hypnotics, narcotics, antiseizure and
antihypertensives.
• Orthostatic hypotension can also increase a risk for falls.
(CDC, 2012).
The next slide shows the Fall Risk Assessment form used to determine the patient’s risk for
falling.

4. _____________________________________________________________
(Name of Facility)
Fall Risk Assessment Form
Resident's Name: Physician:
Examiner 
Assessment Date 
PARAMETER SCORE RESIDENT STATUS/CONDITION
Enter Evaluation Score
Below
A.
Level of
Consciousness/
Mental Status
0 ALERT (oriented X 3) OR COMATOSE
2 DISORIENTED X 3 at all times
4 INTERMITTENT CONFUSION
B. History of Falls
(past 3 months)
0 NO FALLS in past 3 months
2 1 - 2 FALLS in past 3 months
4 3 OR MORE FALLS in past 3 months
C.
Ambulation/
Elimination
Status
0 AMBULATORY/CONTINENT
2 CHAIR BOUND - Requires restraints and assist with elimination
4 AMBULATORY/INCONTINENT
D. Vision Status
0 ADEQUATE (with or without glasses)
2 POOR (with or without glasses)
4 LEGALLY BLIND
E. Gait/Balance
To assess the resident's Gait/Balance, have him/her stand on both feet
without holding onto anything; walk straight forward; walk through a
doorway; and make a turn.
0 Gait/Balance normal
1 Balance problem while standing
1 Balance problem while walking
1 Decreased muscular coordination
1 Change in gait pattern when walking through doorway
1 Jerking or unstable when making turns
1
Requires use of assistive devices (i.e., cane, w/c, walker,
furniture)
F.
Systolic Blood
Pressure
0 NO NOTED DROP between lying and standing
2 Drop LESS THAN 20 mm Hg between lying and standing
4 Drop MORE THAN 20 mm Hg between lying and standing
G. Medications
Respond below based on the following types of medications: Anesthetics,
Antihistamines, Antihypertensives, Antiseizure, Benzodiazepines,
Cathartics, Diuretics, Hypoglycemics, Narcotics, Psychotropics,
Sedatives/Hypnotics.
0
NONE of these medications taken currently or within last 7
days
2
TAKES 1 - 2 of these medications currentlyand/or within
last 7 days
4
TAKES 3 - 4 of these medications currentlyand/or within
last 7 days
1
If resident has had a change in medications and/or change
in dosage in the past 5 days = score 1 additional point
H.
Predisposing
Diseases
Respond below based on the following predisposing conditions:
Hypotension, Vertigo, CVA, Parkinson's disease, Loss of limb(s),
Seizures, Arthritis, Osteoporosis, Fractures.
0 NONE PRESENT
2 1 - 2 PRESENT
4 3 OR MORE PRESENT
Total score of 10 or above
represents HIGH RISK TOTAL SCORE:

5. NURSING PROCESS FOR DECREASING FALLS
Assessment: Is this resident at risk for falls? I’ll use the Fall Risk form to
find out.
Diagnosis: The resident is at risk for falls!!!
Plan: We need to do whatever we can to prevent a fall.
Implement:: Let’s show the resident how to use the call-light for help.
Evaluation: The resident is able to use the call-light effectively and ask for
help.
(Nursing Process, 2011).

6. Demographics
Those born between 1946-
1964.
Fasting growing group.
60% in this group will have at
least 1 chronic condition
by the year 2030.
Goals
To improve the lives of the
older adult.
Preventing injuries to the older
adult.
Improving the older adults’
quality of life.
(Healthy People,2010).
HEALTHY PEOPLE 2020 GOALS

7. WHAT NURSING LEADERS CAN DO………….
**OPTIMAL ASSESSMENT: AT RISK ASSESSMENTS, PROMOTE CRITICAL
THINKING AND EDUCATION.
** TARGETED CARE MANDATES: SIMPLIFY PROTOCOLS, MAKE URGENT
INTERVENTIONS FIRST PRIORITY.
**360 DEGREE SUPPORT: ALLOW PATIENT AND FAMILIES TO HAVE POWER, USE
POINT-OF-CARE STAFF SUPPORT, INSTITUTE BEDSIDE REPORTING.
** BE INNOVATIVE: USE VIDEO MONITORING EQUIPMENT, ALARMS, CORDLESS
CALL LIGHTS. (Mosby’s, 2010).

8. TYPES OF EQUIPMENT TO USE FOR
REDUCING FALLS:
-Pressure alarms that alert staff to a resident getting up unassisted.
-Front and rear wheelchair anti-tippers.
-Automatic brakes for those residents who forget to lock their brakes.
-Wheelchair brake extender handles.
-Dycem mats for residents who slouch or slide to the edge of their
wheelchair.
-Scoop mattresses for those who like to sleep on the edge of their bed.
-Non-skids strips placed on smooth surfaces.
-Wedge cushions to help keep a resident from slouching in their
wheelchairs.
-”Grabbers” so that residents do not have to reach too far to get items.
(Medine, 2011).

9. INNOVATIVE IDEAS
-Use your imagination. Put yourself in that resident’s position and see what
they were looking at when they fell. Were they reaching for something
they could not reach?
-Tailor your suggestions to the resident’s needs. Do they need a brightly
colored call light they can see easier? Is their pathway clear of any
obstacles? Do their clothing fit properly?
-Ask other staff for input. Sometimes you need a 2nd set of eyes? Ask your
resident for their input.
-Educate, educate, educate!!
Hmmmm…………..
??? I wonder???

10. -Assume everyone in the long-
term care facility is at risk.
Being in a new environment
is a risk.
-Educate all immediately.
-Put a care plan in place with
interventions clearly written.
-Identify problem areas
immediately.
-Keep the resident and the family
in the loop with any changes.
-Get all departments involved in
identifying fall risks.
PROPOSED SOLUTION TO REDUCING FALLS

11. -Decrease in falls.
-Decrease in hospital stays.
-Decrease in injuries.
-Decrease in unnecessary expenses.
-Decrease in fatalities and serious
injuries.
-Increase in quality of life.
-Increase in resident independence.
(CDC, 2012).

12. FORMULATION OF A HEALTH POLICY
Most long-term care facilities have a health policy in place for falls.
There needs to be increased education among the staff to ensure familiarity with
all identified risks and interventions.
Staff accountability for those who do not follow protocol. They need to have
disciplinary actions for not using the proper equipment they have been trained
on.
Possible incentives for reducing falls within a facility would possibly keep the rate
of falls down.
Facilities can increase budgets if needed to accommodate new state of the art
monitoring equipment.

13. REFERENCES
Centers for Disease Control and Prevention. (2012). Falls in nursing homes. Retrieved from www.cdc.gov/homeand
recreationalsafety/falls/nursing.html
Health People 2020. (2012). Older adults. Retrieved
from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=31
Medline Equipment Catalog. (2011). Adaptive equipment fall prevention
Mosby’s Nursing Suite. (2010). Nursing takes the lead: nurses have a big role in preventing “never events”
Retrieved from http://confidenceconnected.com/connect/article/nursing_takes_t
he_lead_nurses_have_a_big_role_in_preventing_never_even/