FALL INVESTIGATION

For residents experiencing a fall, or a sudden increase or pattern of falls, this checklist may be used as a tool to help determine the cause of the fall(s) and to assist in fall prevention planning. Any item marked “yes” should have immediate follow-up with the appropriate disciplines, adjustments made to service agreements, family and healthcare practitioner notifications. Include new residents with a history of falls prior to move-in to also determine a plan of prevention. This tool can also be used with an incident report for investigational and prevention purposes.

DATE OF CURRENT FALL: DATE OF LAST FALL:

CURRENT DIAGNOSES OR HEALTH CONDITIONS THAT COULD CONTRIBUTE TO FALLS (i.e. cardiac conditions, hypotension, stroke, diabetes, osteoporosis, Parkinson’s, hypothyroidism, dementia, seizures, fractures, etc.)

DIRECTIONS: Check “yes” or “no” and circle appropriate interventions and/or risk factors:

YES / NO / INVESTIGATION AREAS
Is the resident on any new medications or any recent medication changes? List here:
  • OTC meds, possibly reacting with prescription meds
  • Monitor and review meds for side effects or contraindicated meds
  • Request pharmacy consultation
  • Alcohol use with medications

Is the resident on psychotropic medications? List here:
  • Monitor postural blood pressure for changes
  • Notify health care practitioner of changes
  • Request psych evaluation
  • Monitor for complaints of muscle stiffness, tremors, sleepiness, fatigue, confusion, balance problems

Does the resident exhibit signs/symptoms of dehydration? Does the resident take diuretic medications? List here:
  • Check skin turgor, dry flaky skin or dry mucous membranes
  • Request lab order for electrolytes
  • Encourage fluid intake unless contraindicated
  • Medication review for potential side effects
  • Observe dietary intake
If symptoms exist or persist, notify healthcare practitioner
YES / NO / INVESTIGATION AREAS
Does the resident complain of dizziness, vertigo, or lightheadedness?
  • Auditory impairment?
  • Make a medical appointment to check ears
  • Medication review for possible side effects
  • Check BP for postural hypotension
  • Complaints of shortness of breath? Chest pain?
  • A change in balance/gait?
  • Assist with transfers and/or ambulation?

Is the resident fatigued due to stress or lack of sleep with generalized weakness? Hemiparesis? Stroke? Explain:
  • Encourage rest periods
  • Review dietary intake
  • Monitor weight
  • Request PT evaluation
  • Place daily items within reach
  • Raised toilet seat in BR
  • Review medications for possible side effects
  • Exercise program to strengthen gait/balance

Is there a possibility of UTI or other infection? Does the resident complain of painful urination? Is the urine dark, odorous, or blood tinged?
  • Alert monitor for change in urination, temperature, etc.
  • Request UA with C&S
  • Encourage fluid intake unless contraindicated
  • Toileting assist program
  • Urinary incontinence with urgency/frequency changes?

Is the resident impacted or constipated?
  • Request treatment and/or medication orders for evacuation
  • Alert monitor to assess bowel changes
  • Bowel management program until resolved
  • Exercise program
  • Encourage fluid intake unless contraindicated
  • Review dietary intake/menu for fiber

Is the resident suffering from pain or generalized discomfort?
  • Request pain management orders
  • Assess pain
  • Request X-ray report of hip and/or knee, spine
  • Stiffness in muscles/joints?
  • Osteoporosis?
  • Peripheral neuropathy? Numbness/tingling?

YES / NO / INVESTIGATION AREAS
Is the resident’s vision impaired? When was the last eye exam?
  • Eye appointment of more than one year ago
  • Environmental safety assessment
  • Lighting – use a night light
  • Clean glasses daily, place within reach
  • Place items in sight/reach

Is the resident’s gait impaired? Balance impaired?
  • Request PT/OT evaluation – decreased ROM, posture?
  • Evaluate the use of body mechanics, appliances, ability to transfer
  • Request purchase of new footwear if needed – nonskid, well fitting
  • Check bed height and mattress condition
  • Involve resident in daily group exercises/walking
  • Assess for gait belt use

Did the fall occur outside the community premises or offsite? Where?
  • Check outside area for safety, making adjustments as necessary

Did the fall indicate possible abuse, neglect, or resident-to-resident incident?
  • Provide safety for the resident
  • Follow state reporting guidelines

Is the resident diabetic? IDDM ______NIDDM ______
  • Are blood sugars stable?
  • Diabetic neuropathy?
  • Dietary review
  • Does not follow plan of care related to diabetic management

Impaired judgment or cognition?
  • The resident does not remember to ask for assistance
  • Denial of the aging process
  • Fear, anxiety, confusion
  • Refuses to use assistive device
  • Apathy regarding safety
  • Evaluate for mental changes and safety risk

Other:
IN REVIEW:
Review the resident’s falls over the past three months. Is there a pattern? Check the time of day and location(s) of falls.
EXPLAIN ANY PATTERNS/TRENDS:
PROBABLE CAUSE:
PLAN TO MINIMIZE RECURRENCE:
SERVICE PLAN UPDATED:  Yes  No / DATE:
HEALTHCARE PRACTITIONER NOTIFIED:  Yes  No / DATE:
RESPONSIBLE PARTY NOTIFIED:  Yes  No / DATE:
OTHER: / DATE:
STAFF COMPLETING REPORT: / DATE:
RN CONSULTANT (if applicable): / DATE:

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