Fall Prevention: Residents, Staff, and Visitors

May 2018

A resident fell and broke her hip while in a nursing home undergoing rehabilitation following surgery. She sued the nursing home for negligence. A nurse aide was bathing a resident and slipped on the wet floor and fell, breaking her wrist. A family member was visiting her mother, a resident at the nursing home. After lunch, when the residents were leaving the dining room, the visitor was walking in a hallway leading to the elevator when she slipped and fell on a grape on the marble-type floor surface. She sued the nursing home for personal injury.

Preventing falls is an issue for every staff member in the facility, and every department should be involved in keeping residents, staff, and visitors safe.

There are a variety of strategies that nursing home professionals can utilize to prevent falls and promote resident safety.

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.
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 chair.
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 if needed.
Ensure 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.
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.

Nursing home employees are at particularly high risk of a slip, trip, and fall injury resulting in days lost from work. Their same-level fall rate is almost 3½ times as great as the all-industry same-level fall rate. Slips, trips, and falls account for the second largest proportion of lost-workday nonfatal injuries (26%) in the nursing care facilities sub sector. The incidence rate for nursing care facilities surpasses that for all sectors for same-level and total slips, trips, and falls—19.5 versus 26.4 per 10,000 workers, respectively (Bureau of Labor Statistics, 2011b).

Occupational slips, trips, and falls are preventable. Slippery floors can be addressed through changes such as improvements in housekeeping practices (e.g., correctly using wet floor signs, immediately cleaning up spills, correctly removing grease, aggressively removing ice and snow). Floors that are frequently wet (e.g., bathrooms and kitchens) should be textured so they are not slick when covered with water or other contaminants. Employees assisting residents in these wet environments should consider wearing slip-resistant shoes for additional traction. Employees working in kitchens may benefit from wearing slip-resistant shoes during their entire shift. Training about recording and coding the initial injury event should be provided to workers to ensure that the specifics of each injury event are properly documented and coded in injury records. Workers should also be trained to recognize common workplace slip, trip, and fall hazards and promptly correct them.

Recommended Good Work Practices:

Ensure spills are reported and cleaned up immediately.
Use no-skid waxes and surfaces coated with grit to create non-slip surfaces in slippery areas such as toilet and shower areas.
Use only properly maintained ladders to reach items. Do not use stools, chairs, or boxes as substitutes for ladders.
Re-lay or stretch carpets that bulge or have become bunched to prevent tripping hazards.
Aisles and passageways should be sufficiently wide for easy movement and should be kept clear at all times. Temporary electrical cords that cross aisles should be taped or anchored to the floor.
Eliminate cluttered or obstructed work areas.
Use prudent housekeeping procedures such as cleaning only one side of a passageway at a time, and provide good lighting for all halls and stairwells, to help reduce accidents.
Provide adequate lighting especially during night hours. You can use flashlights or low-level lighting when entering patient rooms.

Staff must be certain that no unreasonable or foreseeable risks of harm to visitors exist. Some guidelines include:

Don’t leave any object in a pathway where visitors (and residents)walk and could trip or fall.
Keep floors clean and dry. Wipe up standing water wherever it is located or, if a large amount, notifying Housekeeping immediately and block the area off in some way.
Provide warning signs for wet floor areas.
Remove all signs once the floor is clean and dry so they do not become commonplace and ignored by staff.
Don’t place any object on the floor in a way that a portion of the object (e.g., the leg of an IV pole) sticks out onto a pathway.
When an object or medical piece of equipment is no longer needed by the resident, remove it and store it in its proper place.
Keep aisles and passageways clear and in good repair, with no obstruction across or in aisles that could create a hazard. Provide floor plugs for equipment, so power cords need not run across pathways.

Preventing falls is the responsibility of every staff member, and a facility-wide program targeting common slip, trip, and fall hazards can reduce a facility’s injury rate.