Fall Prevention – Avoiding F323 Citations

Angie Szumlinski
|
February 2, 2016

Don’t be a victim!  Avoid citations related to F323!

The interpretive guidelines clarify areas such as resident supervision, hazard identification and resident risk, falls, unsafe wandering/elopement, environmental assessment of hazards, and resident-to-resident altercations. The investigative protocol explains objectives and procedures surveyors will need for their investigation. Deficiency categorization provides severity guidance for the determination of the correct level of severity of outcome to residents from deficiencies found at Tag F323.

When was the last time you reviewed the interpretive guidelines or the investigative protocols provided to the surveyors?  These resources spell out exactly what surveyors will be looking at and will guide you in meeting the language of the regulation.

So where do you start?  Let’s look at the risk of falls, how does your team identify residents at risk and what are they doing to prevent the fall/injury?  Here are a few suggestions:

Consistently use a measurable, proven risk assessment tool

  • – “Homemade” tools tend not to be objective or measurable and are not validated
  • – Many tools do not assess the “whole” resident; we need to have a holistic view
  • – Don’t forget physician involvement and medication reviews
  • – If possible, perform a pre-admission assessment either in the community or acute care setting
  • – Assessments should be done immediately upon admission, quarterly and with significant change in condition/post fall
  • – Involve families in the assessment process; an informed family is a happy family

Once the assessment is performed:

  • – Gather the information and analyze the potential impact of the risk factors; remember what may increase risk for one resident may have no effect on another
  • – Determine what risk factors are modifiable and which factors are not
  • – Update the resident care plan to reflect resident specific, measurable interventions and goals
  • – Avoid generic interventions such as “call light in reach” or “remind resident to wait for assistance”
  • – Consider the resident’s cognitive status prior to initiating interventions
  • – Use an interdisciplinary approach to assist in anticipating resident needs; this would include activities (keeping resident stimulated); Dietary (nutritional needs); environmental (hazards), etc.
  • – Document goals and rationale for each intervention; realistic, attainable and resident specific.
  • – Document what the expected outcome is for each intervention; remember “resident will not fall” is not on the list of realistic goals!
  • – Don’t forget to update the care plan with change in condition/post fall! 
  • – Never list fall occurrences by date; surveyors love this free road map!

Remember, residents live in your home because they are not safe to live at their own home.  Be sure that you are addressing their needs timely and effectively to avoid regulatory scrutiny and/or claims.  As always, please review your fall prevention program with your Evolucent risk manager for guidance! 


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