IDPH has cited and fined Randolph County Care Center after a resident there was left unattended while going to the bathroom and fell, suffering a broken hip.
For resident who at risk for nursing home falls, using the toilet can be a surprisingly high-risk activity. The act of sitting and then rising from the toilet can result in a loss of balance. Residents with poor trunk control can slump forward or to one side and slide off the commode onto the floor. Other residents who have strength or balance deficits combined with either dementia, impulsiveness, intermittent or constant confusion, or general poor safety awareness may attempt to get up on their own, leading to a fall. Other times, hurrying to get to the bathroom to avoid having an episode of incontinence may lead to a fall.
Because this is a well-recognized risk, this particular scenario must be addressed in the resident fall prevention care plan. The most common measure is to have a resident supervised while going to the bathroom and reminding the resident to use a call light for assistance. Toileting schedules can also be used to help eliminate accidents associated with a resident hurrying to use the bathroom.
The resident at issue here had been admitted to the nursing home after having a fall at home which resulted in a compression fracture at home. He suffered from dementia and his family was considering long term placement at the nursing home because he was not safe to live at home by himself. The resident was assessed as being a fall risk, and his care plan called for supervision necessary to prevent accidents. Further, his Minimum Data Set (MDS) showed that he needed extensive assist of one staff for transfers to and from the toilet.
On the day of this nursing home fall, he was brought to the bathroom by an aide and helped to the toilet. The aide left the resident in the bathroom to get something from the linen closet. When she returned a few moments later, she found the resident on the floor. It was unclear (and the resident was unable to say due to his dementia) whether he fell from the commode or whether he tried to get up and fell.
The resident was left unattended only for a few moments, yet this fall occurred. Unfortunately, this is all that it takes sometimes, which is why the care plan needs to be carried out on a day-to-day, shift-to-shift basis. This fall could have been averted by simply getting the needed supplies before bringing the resident to the bathroom or by calling for help from a fellow staff member.
The resident was brought to the hospital where he wad diagnosed with a fractured hip. Most fractured hips are repaired surgically, but it appears from the citation that this resident’s was not. Surgical repair has its own set of risks associated with the use of anesthesia and other intra- and post-operative complications. Foregoing surgery has its own set of risks associated with immobility, in particular the development of bed sores.
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