Nursing home board discusses safety issues

McCOOK, Neb. -- How and why residents fall was discussed by the Hillcrest Board of Trustees meeting Tuesday.

Falls, moderate/severe pain, incontinence and 14 other measures from June-November 2015 at Hillcrest were compared percentage-wise with the state and national level, on the "CASPER Quality Measure Monthly Comparison Report." The report includes short and long stays of residents.

Red Willow County Commissioner Vesta Dack asked the reason behind the falls at Hillcrest. For long stays, Hillcrest reported 59.6 percent of falls, compared to 53.9 percent for the state and 44.8 percent nationally. Falls with major injury (long stay) at Hillcrest were reported at 9 percent, with 4.9 for the state and 3.4 percent, nationally.

Colinda Nappa, Hillcrest administrator, said each time a resident falls, the fall is investigated by a subcommittee to find the root cause. Sometimes it is physical, such as a drop in blood pressure or build-up in earwax that affects balance. Different methods are tried to find the reason for fall and the best way for treatment, she said.

Unfortunately, "people have the right to fall, we don't restrain them," Nappa said. If somebody is determined to get out of bed, they will, she said, adding that years ago, beds were made with siderails to prevent this but patients were getting caught in between the rails. Some patients do well with high-low beds, when beds can be lowered close to the floor, but can cause injury to other patients, Nappa said.

Alarms can be used but they can interfere with dignity issues, Nappa said.

Another method is using the Quality Assurance Report, also distributed to board members on Tuesday. "It takes the guesswork out of it," Nappa said.

This report records each injury and incident and maps it on a graph, so administration can see the day and time incidents occur the most. Intervention methods can then be more specific and accurate, such as scheduling additional staffing during certain times. The report also includes actions taken for treatment. According to the report given to board members, most falls occurred on Monday and Tuesday.