The short answer
After a fall, a nurse should immediately assess the resident for injury, including neurological checks if the resident hit his or her head or the fall was unwitnessed; notify the physician and the family; obtain any needed x-rays or hospital care; investigate how and why the fall happened; and update the care plan with new interventions to prevent another fall. Unexplained injuries such as a fracture with no known cause must be reported to the state.
What the facility should do
- Assess for pain, injury and range of motion before moving the resident
- Monitor neurological signs after a head strike or unwitnessed fall, especially for residents on blood thinners
- Notify the physician and the resident's representative
- Investigate the cause: footwear, lighting, a wet floor, a call bell out of reach, medication changes, an unanswered call for help, or a missing alarm or mat
- Update the fall risk assessment and the care plan
Questions to ask
- Was the fall witnessed? Where and when did it happen, and who found the resident?
- Was the resident supposed to have assistance, an alarm, a low bed or floor mats? Were they in place?
- How many falls has the resident had, and what changed after each one?
- Was the resident on any new medication?
Fractures and head injuries
Hip fractures and brain bleeds are among the most serious nursing home injuries. A fracture with no explanation, or bruising in unusual places, is an "injury of unknown origin" that the facility must report to the state and investigate. Facilities must report alleged abuse or serious bodily injury within two hours, and other alleged violations within 24 hours.
The rules behind this
- 42 C.F.R. § 483.25(d) (accidents and supervision)
- 42 C.F.R. § 483.12(c) (reporting and investigating)
Related questions
This guide provides general information, not medical or legal advice. Rules change; confirm current requirements with the facility, the New York State Department of Health or a professional. Attorney Advertising.