What to Do After a Resident Falls

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What do you think the top cause of nursing home injuries is? If you guessed falls, you guessed correctly!

When an elderly resident in your community falls, the severity of the injury can range from minor scrapes to serious head trauma and even death. Even more worrying is that you can have the most effective patient monitoring system in place to mitigate fall risk — but if you don’t have a response plan in place, the consequences of falls can deal a blow to your facility’s bottom line, reimbursements, and patient satisfaction metrics.

The AHRQ has developed a thorough review of what makes an effective fall response strategy — how many of these procedures has your community implemented?

Alert the Nursing Staff

As soon as a resident falls, nursing staff should immediately be alerted to come and assess the situation. The resident should be not attempt to get up or move until the nurse’s assessment is complete. This assessment should include taking vital signs, asking the resident if he or she is in pain (and how serious, on a 1-10 scale), and checking for bruises, scrapes, cuts, or any type of bleeding. Range of motion for arms and legs should also be evaluated to make sure nothing has been dislocated.

Apply First Aid

If necessary (and the resident is able to stand or sit up), nursing staff should apply first aid after the assessment. And even if the telltale signs of a fracture are not apparent, an x-ray should be performed if the nurse suspects one may have occurred. If the patient is still immobile, a gurney or ambulance should be used to transport the resident to the appropriate facility. Of course, all of these activities and assessment findings should be documented in the resident’s file — and their family should be notified.


If a fracture has not occurred, nursing staff should monitor the resident’s health for several days after a fall — especially for any changes in behavior or injuries caused by the fall that weren’t caught in the initial assessment. Often times, when a resident falls and nobody was there to witness it, neurological damage from a head injury will remain untreated indefinitely. When a fall was not witnessed or a head injury is suspected for any reason, a neurological assessment should also be performed during this monitoring period.

Regroup & Reassess

Finally, once the resident is in stable condition and all imminent health issues have been appropriately addressed. Nursing home staff should assess why the fall occurred and develop a plan to prevent future falls — be it investing in new technology to alert nursing staff as soon as residents begin to move, removing obstacles, making certain elements of the environment safer, or otherwise.   

When falls occur, not only should there be a thorough response protocol in place, but the possibility of negligence on the part of nursing home staff should be seriously evaluated. If the negligence is a consequence of other factors, those should be addressed as well.

Nursing home directors should thoroughly review the AHRQ’s fall response guidelines and if current resources don’t allow for a staffing structure overhaul,, help is on the way.

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