Falls are a frequent occurrence in nursing homes. It is estimated that up to 50% of residents experience one or more falls yearly.¹ Ten to 25% of falls among residents result in a fracture, laceration, or need for hospital care.¹ With CMS’s revised survey guidance for F-Tag 323—“Accidents and Supervision” currently in effect, skilled nursing facilities need to get a step ahead of surveyors to ensure that their fall prevention program is in compliance. More importantly, falls are a major focus of F323, which replaces the old F324 tag for supervision. The purpose of this article is:

•To discuss the key components of a fall prevention program essential for F-Tag 323 compliance.
•To discuss the potential benefits of a new generation position monitor (ie, a wireless fall alarm) in reducing risk of falls and injury and assisting staff with F323 compliance.

KEY COMPONENTS OF A FALL PREVENTION PROGRAM

Table 1.

       The success of fall prevention, to a large extent, depends on facility staff adhering to an organized approach or process of care, which will help identify factors contributing to falls and find solutions to reducing fall risk. The key components of fall prevention consist of the following.
Assessing Fall Risk
       • The main purpose of risk assessment is to identify those residents most likely to fall. The rationale for a risk assessment is that if residents at high fall risk can be identified, then appropriate strategies can be instituted to reduce risk. The presence of certain resident and environmental conditions indicates risk of falling. See Table 1.
       • Baseline fall risk assessments should be completed upon admission (within 2 hours of admission).
       • Reassessment of fall risk must be an ongoing process.A new assessment is completed whenever residents experience a change of condition or medication.
       • On a daily basis, every shift takes responsibility in certain high-risk patients and residents. Whether the patient suffers from recent confusion, takes sedatives, recently fell, or suffered from temporary acute illness, staff is expected to update the assessments. Documentation is revised immediately following any post-fall.
Multidisciplinary Evaluation
       • Following risk assessment, an attempt should be made to identify the cause(s) of all risk factors identified. Since most residents will have multiple risk factors, multidisciplinary referral and evaluation is necessary
       • The risk assessment and subsequent multidisciplinary evaluations completed serve as the basis for selection of risk reduction strategies.
Care Planning
       • A fall prevention program is only useful if there is also an effective treatment or strategy available to reduce risk.
       • For those residents at-risk, strategies (eg, medical, nursing, rehabilitative and environmental interventions) need to be targeted toward identified risk factors.
       • It is important to remember that as risk factors change, strategies may have to change as well.
Assessing Falls
       • All residents who fall should receive a post-fall assessment. The purpose of this assessment is to discover what caused the fall and to reduce the risk of future falls.
       • Important components of the post fall assessment include:identifying all internal and/or external factors contributing to the fall and identifying the presence of any new or additional risk factors. This information is useful in conducting an analysis of the fall.Through inquiring, what happened and why it happened, designates appropriate strategies to prevent further falls.
Monitoring
       • Monitoring or follow-up of the resident’s care plan should occur regularly.
       • The purpose of monitoring is twofold. First, to evaluate the effectiveness of strategies designed to reduce falls and/or fall risk. Second, to decide what to do next if the strategies are not effective in reducing risk.

THE FALLSAVER^™ POSITION MONITOR
       Fall alarms are widely used as a means to alert nursing staff that “at-risk” residents who should not leave their bed or chair unassisted are in fact doing so. Theoretically, the alarm allows the nurse or nurse assistant to intervene and prevent a fall or promptly care for the fallen person.² NOCwatch International located (Crystal Bay, Nev) recently developed a new generation fall alarm, the FallSaver^™ Position Monitor (www.fallsaver.net). The monitor represents a promising solution to help staff prevent both falls and injuries.
       The FallSaver^™ Position Monitor consists of a transmitter patch and receiver alarm. The transmitter patch (about the size of a credit card) is applied to the lateral or dorsal side of the resident’s right or left thigh in a position that is comfortable for the resident. Author’s Note: An alarm is activated by a change in position or spatial orientation. When the resident attempts to stand from a bed, chair, wheelchair, or toilet (resident’s leg becomes weight-bearing) the transmitter patch will send a signal to a receiver alarm, which will then sound the alarm.
       Beneficial features of the in-room receiver alarm include:
       • Compatibility with most existing nurse call systems
       • Snooze button deactivates alarm while staff is assisting resident
       • Manual or automatic reactivation of snooze button
       • Range of alarm is about 100 feet from transmitter, through doors and walls
       • Rechargeable battery allows receiver to be attached to wheelchair and follow patient
       • Low battery light warns when patch needs to be replaced.
       According to the manufacturer, FallSaver^™ Position Monitor is suitable for all resident types.This includes lightweight patients (ie, the alarm is not dependent on weight to work), restless patients (ie, the alarm is not defeated by excessive movement), and incontinent patients (ie, the alarm is not defeated by moisture and the adhesive patch is waterproof).
       FallSaver^™ Position Monitor is designed specifically to:
       • Detect unsafe bed, chair, wheelchair, and toilet egress
       • Detect unsafe bathing activity (unsafe shower/bath chair egress)
       • Support immediate monitoring needs (easy to apply/simple to set up)
       • Monitor residents with more than one risk factor (unsafe bed, chair, toilet or unsafe bathing activity).

IS FALLSAVER^™ EFFECTIVE?
       FallSaver^™ Position Monitor has been shown to reduce falls by 50% to 90% and fall-related injuries by over 82% in two clinical trials of nursing home residents— one of which was a randomized control trial.^3,4
       Findings from these two studies report that:
       • FallSaver works well for patients with dementia and other residents who cannot remember to call for assistance, or just don’t want to bother the nurse.
       • FallSaver’s adhesive transmitter patch is well tolerated and no serious adverse effects have been observed.
       • FallSaver does not generate false or nuisance alarms (it does not send an alarm unless the resident is trying to stand).
       • FallSaver provides staff with useful reminders to assist in making sure residents are effectively covered (low battery warnings, resident too far from receiver warnings, etc).
       • FallSaver is staff, family, and resident friendly; there is a high level of staff, family, and resident acceptance of the device.
       Based on the results of these studies, FallSaver™ Position Monitor appears to be a useful and cost-effective component of a multifactorial fall intervention program.

USING FALLSAVER POSITION MONITOR TO ASSIST STAFF WITH F323 TAG COMPLIANCE

       According to F323 guidance, “Facilities are obligated to provide adequate supervision to prevent falls. Adequate supervision is defined according to the type and frequency of supervision, based on the individual resident’s assessed needs and identified hazards in the resident environment.Tools or items such as fall alarms can help to monitor a resident’s activities, but do not eliminate the need for adequate supervision.” Consequently, FallSaver^™ Position Monitor, is not to be used in lieu of supervision—only in combination with adequate supervision, can the device serve as a useful tool in assisting staff assess and monitor fall risk.
       Residents most likely to receive benefits from the FallSaver^™ Position Monitor include those individuals with:
       • Impaired mobility and/or gait/balance
       • Impaired mental status
       • Situational conditions placing resi- dents at fall risk (eg, new admission, floor-to-floor transfer, post fall, change of condition or starting fall risk medication).

USING FALLSAVER^™ TO ASSESS FALL RISK
       FallSaver^™ Position Monitor can serve as an assessment tool by reliably identifying who is at risk of falling, allowing staff to intervene in time to prevent falls:
       1. Be sure to thoroughly complete a fall risk assessment. Table 1 represents a list of common risk factors to assess. Upon identifying mobility impairment, gait/balance impairment, mental status, impairment and/or one or more situational conditions, assume each resident is at high risk of falling, unless staff have reason to believe a fall is not possible (the resident is not able to transfer and ambulate without assistance).
       2. Insist the resident wear FallSaver^™ Position Monitor for a period of 72 hours (3 days) to 1 week. FallSaver can identify which patients are at risk by alarming staff each time residents attempt to get up. Residents attempt to get up for a variety of reasons. If they forget to call for assistance, they do not want to call, or they just don’t want to bother you. Staff can adjust their attention and care to each individual resident’s habits and needs.
       3. At the end of the assessment period, use staff judgment and FallSaver alarm patterns to assess which individuals should remain on the alarm.

USING FALLSAVER^™ TO MONITOR FALL RISK FallSaver^™
       Position Monitor can also serve as a care planning tool by monitoring the frequency of attempts to leave the bed, chair or wheelchair, which can help identify emerging trends and interventions. Coupled with ongoing risk assessments, FallSaver can inform staff about a resident’s habits. For example, a resident may consistently attempt to arise at a certain hour to go to the bathroom, while another resident may get up at nonspecific times driven by an urge to wander.As a result of such a “history,” staff can adjust their attention and care to each individual resident’s habits and specific needs.

CONCLUSION
       A fall in a nursing home resident is a possible cause of citation under F-Tag 323. By following an organized approach to fall prevention and utilizing the FallSaver^™ Position Monitor to assess and monitor fall risk as appropriate, staff will put forth much effort toward keeping residents safe and avoiding F323 survey deficiencies.