| Falls In Skilled Nursing Facilities (SNF) |
| Counselor, Patients who are long term residents in SNF are by definition in a compromised state of health, usually from multiple chronic medical problems. These patients are often weak, are subject to lightheaded spells, become confused and have significant deficiencies of mobility and balance. Falling, sometimes frequent falling is thus a common occurrence for these patients. The consequence of these events can range from simple, inconsequential bruising to severe complications such as broken bones to intracranial hemorrhages. Furthermore, even relatively simple additional stresses imposed on an already debilitated state can have long term effects on a patient's overall medical condition over and above the specific effects of the fall itself. For example, it is well known that such patients who sustain a fractured hip have much higher 6 month mortality even after the fracture has healed and baseline mobility has been re-established. We value all your comments, so, if you have a suggestion for a newsletter subject but haven't submitted it yet, or if you have already submitted one but think of another, please take a minute to let us know by clicking on your "Reply" button and dropping us a note. To learn more about AMFS, Inc., the organization run by Physicians and Attorneys that provides medical experts and case review services nationwide, and has produced the following informational newsletter to aid you in understanding complex medical issues, please click here - www.medicalexperts.com. |
|
| Causes: A: Patient characteristics. - Dementia associated with "sundowner" syndrome - nighttime confusion is a most common occurrence. In this situation, a patient wakes up in the middle of the night, not knowing where he/she is, experience a drop in blood pressure from arising too quickly, have a momentary dizzy spell or loss of consciousness and fall.
- Visual disturbance where a patient cannot see well enough to guide his/her steps.
- Arthritis and other orthopedic problems that compromise gait capacity.
- Old strokes associate with weakness, partial paralysis and loss of balance.
- Multiple medications that cause drops in blood pressure, lack of positional compensation when arising, medications which cause sleepiness, lack of awareness & balance and diabetic medication, which cause low blood sugars are also causes.
B: Environmental Factors. Such things as slippery floors, uneven surfaces, blind corners, insufficient lighting and improperly placed beds and rails are specific factors in the SNF environment. |
|
|
|
| Interventions: Incident reporting is an essential element in preventing falls. Assessment of the causative factor for each fall must be recorded for each individual patient and also noted in aggregate terms for the whole facility. Patients who are frequent fallers must be carefully assessed for underlying causes as noted above and a risk assessment made. In addition, simple precautions, such as anti-skid strips around beds and bathrooms, need to be implemented. Beds should be lowered at night and bed rails raised. Mobility and balance evaluations are important methods of assessing individual risks and point to specific, patient- oriented interventions. Ameliorating the potential severity of effects of falls in certain patients should also be undertaken with consultation from the attending physician. This would include such things as wearing hip protectors in high fall risk patients and having patients who are on anticoagulants and at high risk for falling wear crash helmets to prevent the most disastrous complication of intracranial hemorrhage. Treating osteoporosis is also important so bones are less likely to break with minimal or moderate trauma. |
|
|
|
| Medical/Legal Pitfalls & Conclusion: Whereas not all falls are preventable even in the best of circumstances with this group of patients, each SNF must have written protocols and policies reflecting the principles outlined above for dealing with falls in its facility. These policies must include ongoing monitoring and evaluation by nursing and physician staff, physio and occupational therapists and careful attention to prompt triage and treatment for injured patients. Regular staff training and updating of policies are the only way that an SNF can adequately fulfill its duty and standard of care to its long term patients. |
|
|
|
|
Since 1990 and through 100,000+ nationwide cases, AMFS, Inc. (American Medical Forensic Specialists) has been providing plaintiff and defense attorneys in-house case evaluations as well as access to a carefully screened, nationwide panel of more than 7,500 board-certified medical experts practicing in all specialties and regions of the country. With just a single phone call, you reach an in-house staff physician who will assist you in clarifying the medical issues present in your case, identifying the medical specialties involved and interviewing prospective experts from our panel for your case. Whether you need a physician to review your case, testify as an expert, perform an IME, or perform any other task in the medical-legal field, in any region of the country, AMFS can help. As always, our mission is to provide counsel with the most efficient way to retain quality experts in a timely, cost effective manner. Call Today to Speak with an AMFS Staff Physician at NO Charge. Or use this handy form to submit a case for a Quick Review. Thank you for your time,
Attorney & Physician Advisory Board
CALL TOLL FREE: 1-800-275-8903 |
|
