How to Reduce Falls in Skilled Nursing Facilities

According to the Centers for Disease Control and Prevention (CDC), more than 300,000 older adults are admitted to U.S. hospitals for a hip fracture every year, accounting for just a fraction of the millions of falls this demographic reports. As we age, even a minor trip can lead to injuries and lengthy recovery stays, and if it happens once, it's even more likely to happen again.

People in skilled nursing facilities are at even higher risk than the general public of falls and fall-related injuries, as many residents in these locations are recovering from other injuries and procedures. And though most nurses and physicians have their own strategies for preventing patient falls, skilled nursing facilities should have protocols in place to enhance resident safety.

Understanding the Scope of Fall Risks in SNFs

Regardless of age, everyone has some risk of falling every day. However, older adults tend to face higher risks due to key intrinsic and extrinsic factors. Intrinsic factors refer to obstacles the patient themself faces, such as mobility impairments, medication effects and side effects and overall cognitive decline. Extrinsic factors that contribute to falls in SNFs include environmental hazards that can easily trip someone up, care protocols that encourage movement and even staffing levels, which may prevent nurses from being available when patients need them.

Just as the risk for older adults falling is higher, so are the consequences of it happening. Aside from the physical complications of joint and bone injuries, among others, a damaging fall can have lasting effects on a patient's psyche and even the center's finances. A fall that leads to mobility concerns can contribute to depression, anxiety and other mental health concerns. It may also mean that the patient requires more observation, medication and staff support.

In nursing homes and skilled nursing facilities, approximately half of all patients will experience a fall annually. An additional third of those people will fall again within the year. With these statistics and their consequences in mind, implementing fall reduction strategies in post-acute care should be at the top of every center's to-do list.

Evidence-Based Fall Reduction Practices in SNFs

Government organizations like the Agency for Healthcare Research and Quality (AHRQ) have spent significant resources exploring how falls happen in skilled care centers and what physicians and nonmedical staff can do to decrease their frequency. Their evidence proves there are countless ways to reduce falls and fall severity that build on resources you already have, like:

• Completing comprehensive fall risk assessments: Every patient has their own fall risk, and a range of screening tools can help nurses and physicians identify whose risk is highest. Implement a checklist like the Morse Fall Scale, STRATIFY or the Hendrich II Fall Risk Model to allocate your resources best based on those most likely to be injured. Then, continue to evaluate each person regularly so you can update their standing as their situation evolves.
• Implementing staff training and awareness programs: Whether they are at risk or not, anyone can fall, so every professional in a skilled nursing center needs to know how to handle it. Everyone from top-level leaders to nonmedical support staff should be trained on what to do if they witness a patient fall as part of their standard training protocols. Unsure of how to create a training program? The CDC has plenty of information about preventing falls in health care facilities.
• Developing strength and mobility programs for patients: Even though patients may already be involved in physical therapy or using mobile assistance devices, there may be ways for them to get even more out of their time in your SNF. For example, introducing site-wide exercise programs as a way to connect with other patients can encourage people to attend, and ensuring you have mobility aids available at all times can give people support whenever they need it without feeling they're being babied.

Fall Prevention Protocols for Skilled Nursing Facilities

While these evidence-based practices are excellent methods of preparing your staff to handle or prevent falls, there are also a number of ways you can help your clients directly based on their specific needs. When your focus is on the best outcomes for your residents, these practices can reduce fall risks and simultaneously provide residents with better overall care: 

• Develop individualized care plans: You already develop resident-specific care plans for your patients, providing you with the perfect opportunity to start a fall risk assessment and implement fall reduction efforts from the start. Doing so ensures the entire care team and the resident's family and caregivers are aware of and can actively assist in preventing injuries.
• Optimize medication management: Medication side effects like fatigue and dizziness can make even a low-risk patient susceptible to injury. Pharmacists and anyone involved with medication management in a skilled nursing facility should monitor reactions carefully and be ready to adjust dosages or medication types as soon as unfavorable and potentially dangerous symptoms appear.
• Collaborate with care teams: Physicians, nurses, therapists and anyone else involved in resident care have a responsibility to prevent falls where possible and address them immediately when they happen. Every person involved in a patient's care plan should be briefed on how to conduct post-fall evaluations and inform staff of changes in care plans. Working with a care team also ensures someone is present as much as possible to mitigate avoidable risks.
• Encourage environmental changes and assistive device use: Fall prevention protocols for skilled nursing facilities should extend across the entire campus, and often that means adjusting key features of your center, like grab bar placement, bathroom accessibility and resident risk alarms. Combined with ensuring your patients are using any necessary assistive devices properly, adjusting the extrinsic factors contributing to falls can significantly lower fall instances.

Measuring Success — Tracking and Improving Fall Prevention Efforts

Many of these suggestions and protocols can start saving lives and improving the quality of patient lives as soon as they're implemented — and it shows. While it may be apparent that you are seeing happier, healthier patients, you will likely need to provide metrics leadership and evaluators. Luckily, there are plenty of key performance indicators (KPIs) you can keep track of that assign a quantitative analysis of your progress, such as:

• Fall rate: The fall rate measures the amount of falls that take place per 1,000 resident days. A decrease in this number is the ideal way to measure improvement.
• Tailored intervention rate: This indicator measures how many high-risk residents you have for which you've designed a personalized care plan that addresses common fall concerns.

Other ways you can exhibit your commitment to reducing falls in skilled nursing facilities include:

• Maintaining fall prevention protocols
• Continually training and recertifying staff in fall reduction and prevention practices
• Prioritizing safety initiatives as a staple of your operations
• Bringing in trained professionals to assist you in patient monitoring and care

Start Improving Resident Safety Through Fall Prevention Strategies Today

Whether you're looking at how to reduce falls in SNFs or otherwise determining how to improve patient outcomes, Medrina's staff and experienced physiatrists can help. Our trained professionals are medical experts with specific experience in skilled nursing facilities and advanced patient care. We collaborate with on-site and patient physicians to ensure patient safety, confidentiality and care coordination, which leads to better outcomes for our patients and partners.

Arm your practice with the best tactics to reduce falls in SNFs by contacting our post-acute experts and letting us join your center to gain more support in your operations and reduce patient falls, injuries and chances of malpractice.

Content Reviewed By: Matthew Cowling, D.O.
Chief Clinical Officer

Dr. Cowling is Board Certified in Physical Medicine and Rehabilitation, with a specialized focus on Subacute Rehab, Orthotics and Prosthetics, and the non-surgical management of Musculoskeletal Injuries. He graduated from Michigan State University College of Osteopathic Medicine and completed his residency and specialty training in PM&R at the University of Wisconsin.

Dr. Cowling has a deep passion for teaching and advancing the field of Physiatry in post-acute care. As Chief Clinical Officer at Medrina, he works to spearhead the advancement of physician protocols, education, and communication within the clinical team.