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Thank you, Rena.
----- Original Message -----
Sent: Saturday, December 27, 2003 12:54
PM
Subject: Re: Definition of a Fall in
writing
CMS has made itself clear on this topic in the
RAI User's Manual excerpt cited in the e-mail below. The RAI User's
Manual instructions are the federal regulations governing this matter.
If you are responsible for coding the MDS and attesting to the accuracy of
that item and if the dispute is specifically related to how to code this type
of a fall on the MDS, and the federal regulations themselves are not resolving
the dispute, I recommend that you contact the office of your state RAI
coordinator and request a written response to your question from
them.
When it comes to deciding what to include in facility incident
reports, that is an administrative policy decision that should be made by your
administrator in consultation with the DON and the medical director. If
this part of the issue is not within your area of responsibility, I recommend
that you remove yourself from the dispute. You have provided the
pertinent regulations and stated your opinion. The decision and
accountability fall to others.
Rena
Subj: Re: Definition of a Fall in writing
Date:
12/27/03 9:28:55 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Deanna:
Thanks, I already had this,
and it didn't work. The DON stated that since it said from the low bed
to the floor, that the mat, since it was protective, was not really a
fall. I have spoken until I am blue in the face, and they insist that
the mat does not constitute a fall I do remember someone, Rena,
maybe(?) listing something that was said at the last conference or maybe
from a letter, etc., discussing the issue further, and stating specifically
that a change from one surface to a lower surface was to be considered a
fall until shown otherwise. Maybe I am hallucinating, as well.
Corey
----- Original Message -----
From: Deanna J. Ogle
To: '[EMAIL PROTECTED]'
Sent:
Friday, December 26, 2003 7:58 PM
Subject: RE: Definition of a
Fall in writing
This is directly from the latest update to the
MDS 2.0 manual (December 2002). According to CMS, even if they roll off a
bed onto a mat on the floor, and that is what is care planned for that
resident, it is still a fall and should be noted and assessed, to assure
that the plan of care was followed. That is a specific example in the
manual, item d below. You might want to point that out to your DON and let
her know that she is misinformed on this issue. I know that incident
reports were one area that surveyors in WA state focused on last year and
you will want to make sure you are following the latest updates from CMS..
"Clarification:
??
Current CMS
policy regarding falls includes:
Revised--December 2002
Page 3-146 and 147 CMS's RAI Version 2.0 Manual CH 3: MDS Items [J]
a)
An episode where a resident lost his/her balance and would have fallen,
were it not for staff intervention, is a fall. In other words, an
intercepted fall is still a fall.
b) The presence or absence of a
resultant injury is not a factor in the definition of a fall. A fall
without injury is still a fall.
c) When a resident is found on the
floor, the facility is obligated to investigate and try to determine how
he/she got there, and to put into place an intervention to prevent this
from happening again. Unless there is evidence suggesting otherwise, the
most logical conclusion is that a fall has occurred.
d) The
distance to the next lower surface (in this case, the floor) is not a
factor in determining whether or not a fall occurred. If a resident rolled
off a bed or mattress that was close to the floor, this is a fall. The
point of accurately capturing occurrences of falls on the assessment is to
identify and communicate resident problems/potential problems, so that
staff will consider and implement interventions to prevent falls and
injuries from falls. In the instance of a resident rolling off a mattress
that is close to the floor - even though this is still recorded as a fall,
it might be true that staff have already assessed and intervened, and that
placing a bed close to the floor to avoid injuries from falls is the
intervention that best suits this individual
resident."
Here is the link to the
manual online if you don't already have it bookmarked.
http://www.cms.hhs.gov/medicaid/mds20/man-form.asp
Deanna J. Ogle,
RN
Care Manager
St. Francis Extended Health
Care
3121 Squalicum Pkwy
Bellingham, WA
98225
(360)734-6760, ext. 322
[EMAIL PROTECTED]
-----Original Message-----
From: Corey Ali
[mailto:[EMAIL PROTECTED]
Sent: Friday, December 26, 2003
4:19 PM
To: [EMAIL PROTECTED]
Subject: Definition of a
Fall in writing
Some time ago, we had a
discussion with a number of references, regarding that a fall was a
nondeliberate change from one surface to another. I do have the CMS
RAI manual definition for my facility, but the DON and unit managers still
insist that if a patient falls from a bed to a falls mat on the floor next
to a bed, that it is not a fall, and that no record of that event be done
in an Accident &Incident report, etc. It is not covered on the
24 hour sheet, and almost never in the nursing notes.
Could someone point me to
some documentation indicating that a fall from the bed to a matt next to a
bed should be coded as a fall?
Thank,
Corey
Rena R. Shephard,
MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
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