Long-Term Care

Identify fall risks at admission

LTC Nursing Assistant Trainer, February 12, 2009

Residents are at high risk of falls and other injuries during the first week of admission, when the resident is new to the facility. Occasionally, the first fall causes serious injury, but often there is more than one fall with no injuries before a fracture or other serious injury occurs. No risk screening tool alone will identify all at-risk populations or risk factors. Take a fall history upon admission. Do not wait until the MDS and other risk assessments are done to care plan the fall risk. Risk factors that can be identified at the time of admission include the following:


• Surfaces. Most elderly persons fall on a level surface, whereas children fall from heights.
• Resident has history of stroke, cognitive impairment, arthritis, incontinence, and various other cardiovascular, neuromuscular, orthopedic, or psychiatric diagnoses.
• Delirium.
• Resident is acutely ill/has a condition that alters the ability to metabolize and excrete drugs.
• Resident is taking antipsychotics, antianxiety drugs, sedatives/hypnotics, antidepressants, cardiovascular medications, laxatives, or diuretics.
• Residents takes four or more drugs daily.
• Resident uses restraints/siderails.
• Resident has a history of previous falls.

This is an excerpt from HCPro’s book The Long-Term Care Nursing Desk Reference, written by Barbara Acello, MS, RN.

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