For many years MN Department of Health expected facilities to have a fall intervention with every fall. This left providers spending time scrambling with finding fall interventions instead of spending time drilling down the true cause of the fall. The reality is that not every fall requires a fall intervention. In fact, the resident is much better served by assessing the cause of the fall.
As a result of this practice some facilities have struggled with letting go of the habit of placing an intervention with every fall. After all, what is an intervention anyway? MN Dept of Health is no longer expecting facilities to have a device in place to prevent falls but rather an assessment that determines the likely cause of the fall and work towards negating future falls.
Where does that leave fall intervention equipment such as fall alarms & floor mats? Each resident is to have an individualized assessment. Based on that assessment interventions are implemented. An example of an appropriate fall intervention might be a night light in the bathroom at night. Another example might be looking for the fall trends at night and offering to toilet the resident just before the expected fall time frame. Additionally, looking at symptoms of extreme restlessness and identifying that as terminal restlessness which is a indicator for a referral to hospice. All of these are examples of root cause analysis.
Why not use a floor mat as an intervention? All of the studies to date have revealed that floor mats actually cause residents to trip thereby contributing to the overall fall risk.
What about fall alarms? Fall alarms actually startle the resident and can actually wake them up. The end result is failure to rest adequately and more frequent attempts to rise without assistance. Quality of life has been assessed to be negatively impacted by the use of fall alarms. MN Dept of Health is now looking at fall alarms almost like they look at restraints due to the negative impact on quality of life. There is no evidence to support that fall alarms prevent falls. What the alarm does is tell staff after someone has fallen. This then becomes a device for staffing as it is not preventing falls.
There are fall alarms that are quiet and ring via a page to the direct care staff. This is certainly an improvement but again it only tells staff after a fall has occurred. The direct care staff know their residents. They know when they are restless and when they need to be toileted.
Where the system fails is that we as nurses sometimes fail to ask detailed questions of the front-line staff so that interventions can be realistic and successful. We as nurses are trained to place an intervention which takes time instead of asking direct care staff and even the housekeepers what they are observing out on the floor. We as health care providers become very skilled at institutional routine. In the case of preventing falls we are now in the position of working smarter not harder which is a win/win for the nurses on the floor as well as the residents for which we are all here to serve.