Best practices for post-fall assessment in senior living communities

Approximately half of the residents living in nursing homes experience falls annually, with a third of them experiencing multiple falls¹. Given the prevalence of fall-related incidents, it is crucial for clinical staff to conduct thorough post-fall assessments promptly. These assessments serve to identify injuries and guide appropriate treatment. In this article, we identify the essential steps for conducting effective post-fall assessments in senior living settings, emphasizing safety and optimal care for residents.

When a resident falls, do not assume that no injury has occurred – this can be a devastating mistake. Fall-related injuries are common, so it is important that the clinical staff be able to conduct a post-fall assessment to determine if injuries are present and treat accordingly.

The priority after a resident fall is to ensure basic life support needs are met - airway, breathing, and circulation. If the resident sustained a life-threatening injury, staff should immediately call 911 emergency services (EMS). The clinical staff should initiate CPR if the resident is a code, and no pulse is detected. Actions following a fall include:

Immediate Evaluation and Stabilization: The clinical staff should immediately assess the resident’s condition².

• Check the vital signs and the apical and radial pulses.
• Check the cranial nerve.
• Check the skin for pallor, trauma, circulation, abrasion, bruising, and sensation.
• Check the central nervous system for sensation and movement in the lower extremities.
• Assess the current level of consciousness and determine whether the resident has had a loss of consciousness.
• Look for subtle cognitive changes.
• Check the pupils and orientation.
• Observe the leg rotation, and look for hip pain, shortening of the extremity, and pelvic or spinal pain.
• Note any pain and points of tenderness.

Stabilize and Provide Treatment: If necessary, the clinical staff should stabilize the resident and provide immediate treatment, to include transfer to the hospital if an injury is identified or the status of the resident declines. Quick intervention is essential to prevent further harm.

• Remove any broken equipment or visible causes of the fall.

Notification and Communication: Notify the Primary Care Provider, family or Designated Representative, and regulatory bodies (if the fall meets the State’s requirements for reporting).

Monitor Resident for 72 Hours

• Residents should receive increased monitoring for the first 72 hours after a fall.

• During each shift, clinical staff should record any changes in symptoms, treatments provided, and reference the fall in their notes.
• Vital signs (temperature, pulse, respiration rate, blood pressure), postural blood pressure, and other relevant parameters should be assessed³.

Documentation: Follow the facility fall documentation policy requirements for post-fall documentation. Thorough documentation helps ensure that appropriate nursing care and attention were provided to the resident.

Investigate Fall Circumstances⁴

• Even if the fall was unwitnessed, clinical staff should investigate the circumstances surrounding the incident. Determine what the resident was trying to do before the fall.

• Address the risk factors for the fall such as the resident’s medical condition(s), any environmental issues, or staffing issues.

Revise the Care Plan

• Revise the resident’s care plan to reflect the implemented interventions to minimize the fall from re-occurring.
• Communicate the new interventions to the care team.
• Review the interventions periodically to reduce the chance of another fall.

A fall by a resident does not necessarily indicate a deficient practice because not every fall can be avoided. Remember, falls are common among older adults, and a thorough assessment helps tailor care plans and prevent future occurrences.

Related Resources

• Post-Fall Assessment Checklist for Senior Living
• Post-Fall Assessment Sample Policy for Senior Living

¹ Chapter 1. Introduction and Program Overview | Agency for Healthcare Research and Quality (ahrq.gov)
² AJN, American Journal of Nursing November 2007, Volume :107 Number 11
³ Chapter 2. Fall Response | Agency for Healthcare Research and Quality (ahrq.gov)
⁴ https://www.cms.gov/files/document/r211soma.pdf