• Best Practice Committee of the Health Care Association of New Jersey. Fall management guideline. Hamilton (NJ): Health Care Association of New Jersey (HCANJ); 2006 Sep. 32 p. [41 references]

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

Program Outline

Each facility/provider is encouraged to use this comprehensive guideline to outline and further define its program-specific fall management policy and procedures.

1. Key Elements to a Fall Management Program
   1. Assessments
   2. Dynamic treatment plan
      1. Role of the Interdisciplinary Team or Resident Review Team
      2. Use of devices: restraints, protectors, alternatives to restraints
   3. Re-assessments, implementation and evaluation of treatment plan
   4. Education/awareness

2. Detailed Elements
   1. Assessments
      1. Clinical assessment
         1. Assessment form - recommend rating scale
         2. Completed by registered nurse
         3. Time of completion
            • Admission fall risk assessment completed within 24 to 48 hours of admission
            • If indicated, comprehensive fall risk assessment within 14 to 21 days after admission
         4. Frequency of reassessment
            • Upon a fall
            • Significant change likely to increase fall prediction factors
            • Quarterly for skilled nursing facilities and nursing facilities
            • Semi-annually for assisted living facilities
      2. Rehabilitation assessment
         1. Completed by physical therapist (PT) or occupational therapist (OT)
         2. Form: (e.g., Tinetti Gait and Balance Tool or Berg Balance Scale)
         3. Transfer evaluation
         4. Evaluate for vestibular imbalance
         5. Time of completion (recommend 24 to 48 hours after referral)
         6. Frequency of re-evaluation
      3. Continence protocol
         1. Toilet schedule
         2. Bladder training, as indicated
      4. Mental status assessment
         1. Recall
         2. Judgment (safety awareness)
         3. Complete mini-mental status assessment
      5. Pharmacological assessment
         1. Completed by pharmacy consultant or physician
         2. Review of medication profile as needed
         3. Evaluate risk for osteoporosis and recommend treatment as necessary
         4. Evaluate need for Vitamin D and/or calcium supplements
      6. Environment Assessment
         1. Physical room lay out
         2. Equipment and assistive devices
         3. Lighting
         4. Other
      7. Analysis/Assess Level of Risk Assessment
         1. Identify level of risk based on collective assessments and professional judgment
   2. Dynamic treatment plan
      1. Specific interventions based on results of fall assessment and resident preferences. The interdisciplinary team members must address:
         1. Resident, staff, and family teaching
         2. Room modifications
         3. Resident's daily routines
         4. Mental status/behaviors
         5. Physical limitations
            • Activities of daily living (ADL) skills
            • Continence
         6. Pain
         7. Medication use
         8. Consistent and proper uses of assistive or protective devices based on assessments
      2. Updated information consistently communicated to the staff, resident and family
         1. Staff
            • General classification system identifying resident's potential to fall
            • Summary of assessments/changes in plan of care
            • Verbal and written reports
         2. Residents
            • One-to-one education and review
         3. Families
            • Care conferences
   3. Evaluation
      1. Post fall evaluation
         1. Fall Management Investigation or Post Fall Assessment Tool
            • Physical assessment
            • Contributing factors to fall
      2. Reporting mechanism/tracking of falls within the facility
         1. Facility Fall Summary/Analysis
         2. Action of the interdisciplinary team
            • Timely modifications to the treatment plan
            • Family/resident conferences
            • Physical adaptation to room, wheelchair, and/or walking devices
         3. Collective review, identification, and analysis of trends in resident falls throughout the facility (see "Quality Improvement," below)
      3. Facility protocol may include falls management review and analysis by the safety committee, falls committee, interdisciplinary care (IDC) plan committee, quality improvement committee, or other established interdisciplinary group
   4. Education/Awareness
      1. Falls Program In-Service
         1. Staff members
            • Intervals for review of Fall Management Program:
              1. Upon orientation
              2. Semiannual
              3. Post fall evaluation as necessary
            • Contents of review:
              1. Policies and procedures
              2. Documentation standards
         2. Resident
            • Intervals for review of Fall/Safety Information:
              1. Admission
              2. Care plan meetings
              3. Quarterly resident population education on falls management
              4. After a fall
            • Contents of review:
              1. Instructions and information concerning safety awareness
              2. Proper use of call bells, walking devices, wheelchairs, and other assistive devices
         3. Family
            • Intervals for review of Fall/Safety Information:
              1. Upon admission of the resident
              2. Address with family as resident presents need to discuss
              3. Upon discharge of resident
            • Contents of review:
              1. Reasonable expectations from the facility
              2. How they can assist
         4. Department of Health and Senior Services (DHSS)
            • Inform the DHSS staff about the facility's Fall Program and what is the level of implementation
   5. Quality Improvement
      1. Collect falls data (including near miss data)
         1. Post fall tool
         2. Falls summary report
            • Conduct interdisciplinary analysis of information to gain helpful knowledge
            • Review and revise policies and procedures as appropriate
              1. Retrain staff on new policies and procedures
      2. Complete Facility Falls Data summary document
         1. Analyze information
         2. Revise policies and procedures as appropriate
            • Retrain staff on new policies and procedures

None provided

The type of evidence supporting the recommendations is not specifically stated.

• Best Practice Committee of the Health Care Association of New Jersey. Fall management guideline. Hamilton (NJ): Health Care Association of New Jersey (HCANJ); 2006 Sep. 32 p. [41 references]

Not applicable: The guideline was not adapted from another source.

2003 Sep (revised 2006 Sep)

Health Care Association of New Jersey - Private Nonprofit Organization

Health Care Association of New Jersey

Best Practice Committee

Not stated

Not stated

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

None available

This NGC summary was completed by ECRI on July 18, 2005. The information was verified by the guideline developer on July 20, 2005. This NGC summary was updated by ECRI on September 20, 2006. The updated information was verified by the guideline developer on September 25, 2006.

Per the Health Care Association of New Jersey, this guideline is not copyright restricted.