Falls are an enormous issue in long-term care facilities, and are often at the heart of lawsuits against care providers. The medical record is crucial to the defense when piecing together a timeline of what happened—including all the steps the care team took to demonstrate awareness of the patient’s fall risk and attempts to prevent the patient or resident from falling.

When reviewing a medical record, it may help to apply a five-step process that examines the nursing home’s assessment of the resident, its resulting diagnosis and individualized care plan, the steps it took to implement the care plan, and its efforts to evaluate the effectiveness of that plan. There are many interventions a nursing facility can implement to enhance safety for its patients, including these five recommendations to reduce the likelihood of falls:

• Consider discontinuing the use of noisy alarms. It used to be standard practice to place alarms under nursing home residents’ beds and chairs. An individual at risk for falling would trigger the alarm upon standing up unexpectedly. The alarm presumably had a dual purpose: remind residents to sit down, and alert the nursing staff to their movements. But when confused people hear an alarm, their first reaction is generally not to sit back down—but to run away from the noise. This type of quick, startled movement, paired with confusion, can lead to stumbling or tripping. Although staff members may be on their way to the resident’s room, it is generally too late at that point to prevent a fall.
• Consider using silent alarms or motion sensors. As the previous alarm system falls out of favor, nursing homes are implementing newer technology, such as motion sensors or alarms that only sound at a nurses’ station, rather than in a resident’s own room. These still serve the purpose of alerting a nurse to movement, without the side effect of startling or confusing the resident.
• Strive for noise reduction and a calming atmosphere. When it’s noisy, a resident may find it difficult to fall asleep and may become restless. This could lead to getting up unassisted for a drink of water, to use the bathroom, or to investigate the cause of the sounds. All of these actions heighten an individual’s risk of falling. While sleep deprivation due to a noisy environment can lead to falls, studies show that noise reduction in nursing homes can help reduce the occurrence of falls.
• Increase staffing at key times. Additional staffing may be necessary at certain times of day to properly address residents’ needs, such as post-mealtime and at dusk. Some people may have increased urges to use the bathroom after eating, including those who need toileting assistance. “Sundowning,” a phenomenon causing some residents to become more confused or restless in the evening, can cause individuals with mobility issues to forget that they aren’t supposed to walk on their own. The nursing home may want to consider augmenting their staffing at these times to handle increased demand for services.
• Discuss resident’s histories with their families. Especially among residents who have a history of falling, it’s important to collaborate with their families to develop a pattern of what caused the falls. For example, did they wake up at night to use the bathroom, and fall on the way? Did they fall simply walking through the living room, because they weren’t using their cane? Is there a tendency to trip over throw rugs? Does the person typically get around the house by holding onto furniture or leaning against walls? Once the family member leaves the familiarity of home—along with the methods they’ve used to stay mobile—the nursing facility may need to introduce ambulatory aids such as canes or walkers. The family can help the facility identify the factors that put their loved one at a higher risk for falls.

There are many other clues to look for in the medical record, but it requires a comprehensive knowledge of nursing home care standards, new trends and best practices in long-term care, and an understanding of the types of interventions that may have been necessary in individualized situations. It may be difficult for someone without a clinical background to properly review a complex and lengthy medical record and build a strong defense. Luckily, there are medical legal analysts with a strong grasp of what is relevant in an aging services medical record and exactly where to find that information. What to look for. Contact us for more information about using these analysts to prepare a defense.