Fall Prevention and accidents FTAG 323

F323
§483.25(h) Accidents.
The facility must ensure that –
(1) The resident environment remains as free from accident hazards as is possible; and
(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

42 CFR 483.25(II) (1) AND (2) ACCIDENTS AND SUPERVISION
The intent of this requirement is to ensure the facility provides an environment that is free from accident hazards over which the facility has control and provides supervision and assistive devices to each resident to prevent avoidable accidents. This includes:
• Identifying hazard(s) and risk(s);
• Evaluating and analyzing hazard(s) and risk(s);

• Implementing interventions to reduce hazard(s) and risk(s); and
• Monitoring for effectiveness and modifying interventions when necessary.

Definitions are provided to clarify terms related to providing supervision and other interventions to prevent accidents.
• “Avoidable Accident” means that an accident occurred because the
facility failed to:
- Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and/or
- Evaluate/analyze the hazards and risks; and/or
- Implement interventions, including adequate supervision, consistent with a resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and/or
- Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.
“Unavoidable Accident” means that an accident occurred despite
facility efforts to:
- Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and
- Evaluate/analyze the hazards and risks; and
- Implement interventions, including adequate supervision, consistent with the resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and
- Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.

• “Assistance Device” or “Assistive Device” refers to any item (e.g., fixtures such
as handrails, grab bars, and devices/equipment such as transfer lifts, canes, and wheelchairs, etc.) that is used by, or in the care of a resident to promote, supplement, or enhance the resident’s function and/or safety.
• “Hazards” refer to elements of the resident environment that have the potential to cause injury or illness.
o “Hazards over which the facility has control” are those hazards in the resident environment where reasonable efforts by the facility could influence the risk for resulting injury or illness.
o “Free of accident hazards as is possible” refers to being free of accident hazards over which the facility has control.
• “Resident environment” includes the physical surroundings to which the resident has access (e.g., room, unit, common use areas, and facility grounds, etc.).
• “Risk” refers to any external factor or characteristic of an individual resident that influences the likelihood of an accident.
• “Supervision/Adequate Supervision” refers to an intervention and means of mitigating the risk of an accident. Facilities are obligated to provide adequate supervision to prevent accidents. Adequate supervision is defined by the type and frequency of supervision, based on the individual resident’s assessed needs and identified hazards in the resident environment. Adequate supervision may vary from resident to resident and from time to time for the same resident.

Numerous and varied accident hazards exist in everyday life. The frailty of some residents increases their vulnerability to hazards in the resident environment and can result in life threatening injuries. It is important that all facility staff understand the facility’s responsibility, as well as their own, to ensure the safest environment possible for residents.
The facility is responsible for providing care to residents in a manner that helps promote quality of life. This includes respecting residents’ rights to privacy, dignity and self determination, and their right to make choices about significant aspects of their life in the facility.
For various reasons, residents are exposed to some potential for harm. Although hazards should not be ignored, there are varying degrees of potential for harm. It is reasonable to accept some risks as a trade off for the potential benefits, such as maintaining dignity, self-determination, and control over one’s daily life. The facility’s challenge is to balance protecting the resident’s right to make choices and the facility’s responsibility to comply with all regulations.
The responsibility to respect a resident’s choices is balanced by considering the potential impact of these choices on other individuals and on the facility’s obligation to protect the residents from harm. The facility has a responsibility to educate a resident, family, and staff regarding significant risks related to a resident’s choices. Incorporating a resident’s choices into the plan of care can help the facility balance interventions to reduce the risk of an accident, while honoring the resident’s autonomy.
Consent by resident or responsible party alone does not relieve the provider of its responsibility to assure the health, safety, and welfare of its residents, including protecting them from avoidable accidents. While Federal regulations affirm the resident’s right to participate in care planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate, or representative to demand the facility
use specific medical interventions or treatments that the facility deems inappropriate. The regulations hold the facility ultimately accountable for the resident’s care and safety. Verbal consent or signed consent forms do not eliminate a facility’s responsibility to protect a resident from an avoidable accident.
An effective way for the facility to avoid accidents is to commit to safety and implement systems that address resident risk and environmental hazards to minimize the likelihood of accidents.2, 3 A facility with a commitment to safety:
• Acknowledges the high-risk nature of its population and setting;
• Develops a reporting system that does not place blame on the staff member for reporting resident risks and environmental hazards;
• Involves all staff in helping identify solutions to ensure a safe resident environment
• Directs resources to address safety concerns; and
• Demonstrates a commitment to safety at all levels of the organization. A SYSTEMS APPROACH
Establishing and utilizing a systematic approach to resident safety helps facilities comply with the regulations at 42 CFR §483.25(h)(1) and (2). Processes in a facility’s system approach may include:
• Identification of hazards, including inadequate supervision, and a resident’s risks of potentially avoidable accidents in the resident environment;
• Evaluation and analysis of hazards and risks;
• Implementation of interventions, including adequate supervision and assistive devices, to reduce individual risks related to hazards in the environment; and
• Monitoring for effectiveness and modification of interventions when necessary.