The Post-Fall Assessment (w/Video)
Before even beginning a post-fall assessment, the person must be examined carefully for any injury or medical problems that occur as a result of the fall, and for problems that may have occurred prior to the fall and may have contributed to it.
If injuries are found, they should be treated immediately. The person should not be moved or helped up until any injury or medical condition has stabilized and it is safe to do so.
After any immediate medical issues have been addressed, you need to make a post-fall assessment. First, obtain a fall history. Ask the person the circumstances of the fall. Find out if the person can tell you what caused the fall. Did he trip? Did his/her strength just give out? Did he feel dizzy or weak right before the fall?
Be sure to include where the fall occurred, which room and specifically which area of the room, such as near the bed, or at the door. Specific location can be very important in determining if there are hazards that need to be addressed.
Ask if she remembers exactly what she was doing at the time. Was she getting out of bed? Was she turning her body or twisting to look at something? Was she leaning to pick something up?
Try to determine if the fall has left the person with an increased fear of falling. Ask how confident he would be now performing activities that involve mobility, such as going to the toilet, walking unaided, or getting up from a chair.
Then talk to other staff or family members who may have witnessed the fall. This can be particularly important for those with some degree of dementia, but anyone can forget the details of a traumatic event. Witnesses may remember important details that will help determine the cause of the fall.
S - P - L - A - T - T
One way to remember all the important components of a fall history is to use the mnemonic word SPLATT. Each letter suggests one element of a comprehensive report.
The "S" of SPLATT stands for the symptoms that the person experienced immediately before the fall. They could indicate a medical condition leading to the fall.
"P" stands for any previous falls. The circumstances of these may help determine a pattern to the person's falls.
"L" stands for the location of the fall. The location can be a crucial key in deciding what happened, identifying hazards, and anticipating and preventing future falls.
"A" stands for the activity at the time of the fall, whether the person was getting out of bed, or walking, or turning around, or reaching for something.
The first "T" stands for the time of the fall. Nighttime is often associated with falls on the way to the bathroom, or falls due to inadequate lighting.
The second "T" stands for trauma, any injury that was associated with the fall, either causing the fall or caused by the fall.
If you remember SPLATT for Symptoms, Previous falls, Location, Activity, Time and Trauma it will help you make a complete post-fall assessment.
Once the assessment is completed, it can be studied by other caretakers and the fall prevention committee. Staff can try to determine if there were environmental factors involved that can be changed or fixed.
The person should be reassessed as well. Every fall increases the risk factor for future falls. The person's medications should be reassessed, as well fracture status, cognitive status, and any ambulation devices in use.
The post-fall assessment and the reassessment of the person who fell should give the care team enough information to make immediate interventions that are necessary to prevent further falls.
Root Cause Analysis
After the immediate interventions are put into place, the fall prevention team can use the assessment, and any others collected, to perform a root cause analysis to discover, if possible, any root causes that can be modified. A multidisiciplinary falls evaluation can help identify risks that may well affect other persons in the facility.
Any root causes or environmental factor that contributed to the fall should be repaired or altered as soon as possible. The care team should keep in mind that the person who has had a recent fall now has an increased risk of further falls.
In order to ensure the safety of their patients and meet the Joint Commission's goal of reducing the risk of injury from falls, every facility should have a fall prevention program in place and staff designated as a fall risk committee.
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