RE: Definition of a Fall in writing

[Pam Allen]

Title: Message

What we do in our facility is document that the resident was found on the blue mat beside the bed and on the care plan we document the incident and mark it as an expected outcome since the preventative measure was in place and prevented or decreased the injury. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Corey Ali Sent: Saturday, December 27, 2003 12:28 PM To: [EMAIL PROTECTED] Subject: Re: Definition of a Fall in writing 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:   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." Revised--December 2002 Page 3-146 and 147 CMS's RAI Version 2.0 Manual CH 3: MDS Items [J] 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