Minimizing risk in the nursing home

Nursing Homes, Jan-Feb, 1992 by Leo G. Foxwell

Accidents among nursing home residents can cause a variety of problems, ranging from the obvious adverse effects on the emotional and physical well-being of the resident, to negative publicity that ends up reducing nursing home morale and even advmissions. Invariably, they lead to added costs, as well. Fortunately, most accidents are preventable, or can be reduced dramatically, through a sound risk management program. The key is in knowing which situations pose greatest risk in nursing homes, and what to do about them.

Falls While Assisted

Falls cause the majority of injuries in the united States and are, by far, the greatest risk for health-care facility residents. Falls accuont for two-thirds of all large claims against nursing homes.

It is often thought that resident injuries from falls take place when the resident is alone. Such is not always the case. Many injuries occur while residents are being cared for by the staff.

In many cases, defective equipment can cause the problem. A wheelchair with defective brakes, for example, can cause an injury as the resident is being moved to or from the bed and to or from the wheelchair. Periodic checks on the proper operation of equipment is vital to any preventative program.

Bath water temperature is another potential trouble area. Valves that are supposed to keep water temperature below 105[degrees]F are known to fail. Bath water must be checked by the staff regularly to make certain that a dangerously high temperature does not exist.

Lifting a resident is another major source of trouble. Even with mechanical lifts, or the so-called hoyer lift, problems can occur. Residents may slip out of the device if safety straps are not properly used. Residents should be lifted by more than one staff member. Even when using a hoyer lift, two or even three staff members should be present.

The condition of the resident should always be taken into consideration. Some residents require more assistance than others and this should be indicated clearly on their chart. A sound in-service program on this phase of the nursing home's operation is an important part of any risk management program.

Physical therapists tell us that residents should not be lifted under their arms. A gait belt should therefore be used whenever possible, especially when lifting the resident on and off a toilet seat where space is cramped and options for holding the resident are limited. Staff should be instructed on when and how to operate there useful devices.

The shower is another potential, and proven, hazard for falls. Often staff forget to provide safety straps when the resident is in the shower chair.

Preventing Falls

In general, your staff must be alerted to all the potential dangers facing residents and should be trained in proper procedures when handling their charges. Further steps can be taken to reduce the risk of falls.

Certain persons--namely those individuals who use assistive devices, such as wheelchairs, walkers or canes--are the most prone to falls. Also, some residents who are on a number of medications are more prone to fall. Therefore, one of the key risk management tools is to establish a fall profile program that identifies the 10 percent to 15 percent of the residents who are most fall-prone and that directs major attention to these individuals. For example:

1) Upon admission, all residents are given a fall profile assessment and should be reassessed on a regular basis during team meetings.

2) Those individuals in the high-risk category for falling ar eplaced in a falls prevention program.

3) A current list of all residents in the program is posted at the nurse's station.

When a resident is placed in the fall prevention program, identification reminders should be initiated to improve the staff's awareness of the resident. The reminder could include many of the following:

1) A special colored ID bracelet placed on the resident's arm.

or

2) A star or dot placed...

* on the outside door frame of the resident's room.

* above the bed.

* at the call light at the nurse's station.

* on the spine of the resident's medical chart.

* on the nurses aides' worksheets.

3) Room assignment aimed at keeping the resident near the nurse's station for easier observation and, if possible, obtaining a cooperative roommate.

4) Medication reassessment, with a physician or pharmacist as consultant.

5) Scrutiny of footwear.

Visitor Falls

The risk of falling is not limited to residents. Visitors, delivery people and even staff are potential victims of falls that can result in claims against the facility. Some common claims faced by nursing homes include those due to delivery men going up a slippery ramp, a visitor's chair collapsing, a pot hole in the parking lot or a visitor being bumped by an automatic door.

The only way to prevent such problems is through a program that increases the sensitivity of the entire staff to the potential for accidents within and around the facility. Each employee must play a part in noticing, reporting and reducing potential hazards.