|Developing Successful Strategies for
Preventing Falls II
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
- 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
- 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
- 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
- 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.
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.
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
- 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
- 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
- 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
- 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.