What is the most common accident in a nursing home?

Nursing homes aim to provide a safe environment for elderly residents who require assistance with daily activities. However, accidents still occur frequently in these facilities. The most common accident is falls, accounting for over half of all reported incidents. Understanding the causes and risk factors for falls can help nursing homes take preventative measures.

Falls Are The Leading Cause of Accidents in Nursing Homes

Multiple studies have shown that falls are by far the most prevalent accident among nursing home residents. According to the Centers for Disease Control and Prevention (CDC), over 50% of all reported accidents in nursing homes are falls. This amounts to an estimated 1.6 falls per bed annually.

Other relatively common accidents include:

• Medication errors – accounting for around 10% of incidents
• Wandering related accidents – around 6% of incidents
• Choking or ingestion accidents – approximately 3% of incidents

While other accidents occur, falls significantly outnumber all other types of incidents. This makes fall prevention the top priority for improving nursing home safety.

Why Are Falls So Common in Nursing Homes?

There are several reasons why elderly nursing home residents are prone to falling:

• Physical impairments – Most residents have age-related issues like poor balance, muscle weakness, arthritis, and declining vision. These make them more likely to fall.
• Use of medications – Medications like sedatives, antidepressants, and diuretics that are commonly used by the elderly may cause dizziness or unsteadiness.
• Cognitive impairment – Dementia and related disorders impact judgement and awareness of hazards.
• Environmental factors – Slippery floors, poor lighting, obstacles, and other environmental issues also raise fall risk.

While falls can happen anywhere, the most common locations in a nursing home are:

• Bedroom – next to bed, between bed and bathroom
• Bathroom – especially near toilet, tub, and shower
• Hallways and doorways
• Dining area
• Stairways

Assessing Fall Risk Factors in Individual Residents

Since not all residents have the same fall risk profile, nursing homes should assess each individual for factors that make them more prone to falling. This allows staff to tailor prevention approaches.

Important risk factors to evaluate include:

• History of previous falls – The best predictor of future falls is having fallen before.
• Gait and balance – Unsteady walking or needing support while moving indicates high risk.
• Use of assistive devices – Needing a cane or walker is associated with greater fall risk.
• Medications – Psychoactive medications and those with sedation effects are linked to falls.
• Postural dizziness – Feeling faint or dizzy when standing up rapidly flags fall risk.
• Cognitive status – Impaired executive function and visuospatial issues raise risk.
• Continence issues – Needing frequent toileting due to incontinence increases risk.

Assessing each nursing home resident for these and other fall risk factors allows staff to pinpoint who needs closer supervision and preventative measures.

Implementing Fall Prevention Strategies

Nursing homes should take a multi-faceted approach to reducing falls, including:

• Exercise programs – Physical therapy to improve strength, balance, and gait can lower fall rates.
• Assistive equipment – Walkers, grab bars in bathrooms, and mobility aids help compensate for physical impairments.
• Medication management – Reviewing medications and minimizing those that increase dizziness/sedation.
• Environmental safety – Ensuring good lighting, clear walkways, railings, non-slip surfaces, and padded floors.
• Staff supervision – Having staff assist unsteady residents when moving about the facility.
• Safe footwear – Making sure residents wear shoes with non-slip soles and avoid loose fitting slippers.

For residents at very high-risk, bed and chair alarms, video monitoring, or sitter supervision may be warranted to alert staff if they try to get up unattended.

Using Data to Understand Circumstances and Causes of Falls

Nursing homes should analyze data on falls to gain insights into when and why they occur. This allows preventative strategies to be tailored based on evidence. Important data to review includes:

• Time of day falls tend to occur
• Location where most falls happen
• Activities residents were engaged in when falling
• Any environmental factors contributing to falls
• Health conditions and medications of those who fell

Systems like incident reports, fall logs, and root cause analysis help collect this data. It can highlight patterns requiring intervention, such as more staff coverage during high-risk times or installing grab bars in problematic locations.

Using Technology to Detect and Prevent Falls

Technological systems can bolster nursing home fall prevention and detection efforts. Examples include:

• Wearable sensors – Detect falls and alert staff to check on the resident.
• Video monitoring – Computer vision programs can recognize fall motion and notify staff.
• AI analytics – Identify high-risk residents and times/locations requiring more supervision.
• Smart flooring – Sensors detect presence, gait, and may predict fall risk.

When paired with nursing observation and care, technology can enhance risk assessment, fall detection, and prevention.

Staff Education is Vital for Reducing Fall Rates

For any fall prevention effort to succeed, nursing home staff education is essential. All employees should complete training on:

• Risk factors, warning signs, and circumstances associated with falls
• Implementing individualized fall prevention plans
• Assisting residents with transfers and ambulation
• Use of gait belts, wheelchairs, and other assistive equipment
• Reporting falls and near-falls and communicating with care team

Ongoing competency assessments help ensure staff retain knowledge and apply it effectively.

Reporting Falls to Identify Causes and Prevent Recurrence

Any fall incident, even seemingly minor, should prompt nursing home staff to:

1. Check resident for any injuries and provide medical care as needed
2. Interview resident or witnesses to understand what happened before and during the fall
3. Review medications, vision, cognitive status, orthostasis, and other health factors
4. Identify any environmental contributors in location where fall occurred
5. Document details in incident report to inform practice changes
6. Update care plan with additional precautions and prevention approaches

Thorough fall reporting and follow-up can yield insights to prevent repeat falls in that resident or systemic issues to be addressed.

Monitoring and Re-Assessing Fall Prevention Measures

Like any quality initiative, fall prevention programs should be continuously monitored and improved. Nursing homes should:

• Track fall rates monthly to identify trends
• Review circumstances of each fall to inform practice changes
• Re-assess individual residents’ fall risks regularly
• Evaluate prevention strategies and modify if falls increase
• Stay up-to-date on emerging practices to reduce falls

A dynamic, data-driven approach ensures fall prevention efforts remain effective over time.

Collaborating with Healthcare Providers to Reduce Fall Risk

Preventing falls requires an interprofessional approach. Nursing home staff should collaborate with:

• Medical director – To identify high-risk medications and treat underlying conditions.
• Pharmacy – To review drug regimens and suggest safer alternatives.
• Physical and occupational therapy – To optimize mobility and independence.
• Primary care doctors – To manage chronic diseases and medications.
• Home health agency – To ensure continuity when transitioning from hospital.

With strong communication and teamwork, the risk factors contributing to falls can be minimized.

Conclusion

Falls are the most prevalent accident in nursing homes, often leading to significant injury and decline. Amulti-faceted prevention approach addressing risk factors, environment, staffing, care practices, and technology is needed. Fall prevention should be a top priority, with continuous quality improvement processes to reduce incidence over time. Strong collaboration among nursing home staff and healthcare providers is key for keeping residents safe.