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Falls - Definitions and Regulations 

RAI User’s Manual Definitions of Falls

An intercepted fall is still a fall.

An episode where a resident lost his/her balance and would have fallen, were it not for staff intervention, is a fall. 

 A fall without injury is still a fall.

The presence or absence of a resultant injury is not a factor in the definition of a fall. 

When a resident is found on the floor, the most logical conclusion is that a fall has occurred.

The facility is obligated to investigate and try to determine how he/she got there, and to put into place an intervention to prevent this from happening again. 

The distance to the next lower surface is not a factor in determining whether or not a fall occurred.

 If a resident rolled off a bed or mattress that was close to the floor, this is a fall. 

Excerpts from 42 CFR, 483.25(h)(1) Accidents.

The facility must ensure that-
(1) The resident environment remains as free of accident hazards as is possible.
 The intent of this provision is that the facility prevents accidents by providing an environment that is as free from hazards over which the facility has control.

An accident is an unexpected, unintended event that can cause a resident bodily injury. It does not include adverse outcomes associated as a direct consequence of treatment or care, ( e.g. drug side effects or reactions).

 "Accident hazards" are defined as physical features in the nursing home environment that can endanger a resident's safety, including but not limited to:

·        Physical restraints (see physical restraints §483.13);

·        Equipment or devices that are defective, poorly maintained, or not used in accordance with manufacturer's specifications (e.g., wheelchairs or geri chairs with nonworking brakes, and loose nuts and bolts on walkers);

·        Bathing facilities that do not have nonslip surfaces;

·        Hazards (e.g., electrical appliances with frayed wires, cleaning supplies easily accessible to cognitively impaired residents, wet floors that are not obviously labeled and to which access is not blocked);

·        Defective or improperly latched side rails or spaces within side rails, between upper and lower rails, between rails and the mattress, between side rails and the bed frame, or spaces between side rails and the head or foot board of the bed that can entrap limbs, neck or thorax, and can cause injury or death;

·        Handrails not securely fixed to the wall, difficult to grasp, and/or with sharp edges/splinters; and

• Water temperatures in hand sinks or bath tubs which can scald or harm residents.
   

Procedures 483.25(h) (2)

If a resident selected for a comprehensive or focused review has had an accident, review the facility’s investigation of that accident and their response to prevent the accident from recurring.

• Identify the resident triggers RAPs for falls, cognitive loss/dementia, physical restraints, and psychotropic drug use and whether the RAPs were used to assess causal factors for decline or lack of improvement.
• If the survey team identifies a number of or pattern of accidents, in Phase II sampling, review the quality assurance activities of the facility to determine the facility’s response to accidents.

 Probes 483.25(h) (2)

1. Are there a number of accidents or injuries of a specific type or on any specific shift (e.g. falls, skin injuries)
2. Are residents who smoke properly supervised and monitored?
3. If the survey team identifies residents repeatedly involved in accidents or sampled residents who have had an accident:

a)     Is the resident assessed for being at risk for falls?

b)     What care-planning and implementation is the facility doing to prevent accidents and falls for those residents identified at risk?

c)     How did the facility fit, and monitor, the use of that resident’s assistive devices?

d)     How were drugs that may cause postural hypotension, dizziness, or visual changes monitored? 

Special Care Topics for Long Term Care, Vol. I

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