5.1 Fall Prevention
Key Takeaways
- Falls are the leading cause of injury in healthcare and most are preventable
- Risk rises with age over 65, confusion, four-plus medications, incontinence, and unsteady gait
- Keep the bed in its lowest locked position, the call light in reach, and pathways dry and clear
- If a resident is falling, never try to catch them; ease them to the floor and protect the head
- After any fall, do not move the resident, summon the nurse, and complete an incident report
Why Falls Dominate Safety on the Exam
Falls are the single most tested safety topic on the Certified Nursing Assistant (CNA) competency exam because they are the leading cause of injury in long-term care. The Centers for Disease Control and Prevention reports that half to three-quarters of nursing-home residents fall each year, and roughly 20-30 percent of those falls cause moderate to severe injury such as a hip fracture or head bleed. The exam frames almost every fall question around one idea: the CNA prevents the fall before it happens and never sacrifices their own safety to stop one in progress.
Identifying the High-Risk Resident
The nurse assigns a formal score (Morse Fall Scale or Hendrich II), but the CNA flags the day-to-day changes. Memorize these intrinsic and extrinsic risk factors:
| Factor Type | Examples | CNA Action |
|---|---|---|
| Intrinsic (resident) | Age over 65, prior fall, confusion, weakness, urinary urgency | Report any change in mobility or alertness |
| Medication | Sedatives, diuretics ("water pills"), antihypertensives, opioids, four-plus drugs | Expect drowsiness and frequent bathroom needs |
| Sensory | Poor vision, hearing loss, peripheral neuropathy | Ensure glasses and hearing aids are in place |
| Environmental | Wet floor, clutter, throw rugs, poor lighting, new room | Correct hazards immediately |
| Condition | Dementia, stroke (hemiparesis), Parkinson's, orthostatic hypotension | Rise slowly; allow dangling before standing |
Standing Prevention Bundle
These measures are expected on every test scenario and during the skills check-off:
- Call light within reach at all times - the most frequently correct answer on fall items.
- Bed in lowest position with wheels locked whenever you are not at the bedside.
- Non-skid footwear or gripper socks before any transfer or ambulation.
- Clear, dry, well-lit path to the bathroom; remove throw rugs and clutter.
- Toileting schedule - offer the bathroom every two hours and before bed, because urgency drives nighttime falls.
- Personal items reachable: water, tissues, glasses, phone, urinal.
- Assistive device (walker, cane) positioned on the resident's strong side.
When a Resident Begins to Fall
The exam's classic trap offers "catch them" as a tempting answer. Never catch a falling resident - you risk a back injury and may break their bones. Instead, get close, ease them down your body to the floor, and protect the head. The correct sequence:
| Step | Action |
|---|---|
| 1 | Widen your stance and bring the resident close to your body |
| 2 | Guide them slowly to the floor, bending your knees |
| 3 | Support and protect the head from striking objects |
| 4 | Stay with the resident and call for help with the call light or by shouting |
| 5 | Do not move or lift the resident; wait for the nurse to assess |
After the Fall
The nurse must assess before the resident is moved, because moving someone with a hip fracture or spinal injury can cause permanent harm. The CNA reports exactly what happened: where the resident was found, the position, complaints of pain, and any environmental factor. An incident report (occurrence report) is completed as a factual, objective legal record - never written in the resident's chart as an admission of fault, and never speculative.
Orthostatic Hypotension and the Dangle Position
A frequently missed cause of falls is orthostatic (postural) hypotension - a drop in blood pressure when a resident moves from lying to standing, producing dizziness and brief loss of vision. The CNA prevents it by changing positions in stages: raise the head of the bed, help the resident sit and dangle the legs over the edge for one to two minutes, watch for pallor or complaints of lightheadedness, and only then assist to standing. Residents on blood-pressure medications, diuretics, and those who have been on prolonged bed rest are most affected.
If a resident reports feeling faint while standing, lower them safely to a sitting or lying position immediately rather than walking on.
High-Risk Times and Settings
Fall risk is not constant through the day. The exam expects you to anticipate it:
- Night shift - residents wake disoriented in dim light and try to reach the bathroom alone.
- Within an hour of sedating medication - peak drowsiness and unsteadiness.
- During toileting - a leading single cause; rushing or leaving a resident alone on the commode is dangerous.
- The first standing of the day and the first days after admission, when the environment is unfamiliar.
- During shift change, when supervision briefly dips.
Worked Scenario
A resident on furosemide (a diuretic) and lorazepam (a sedative) calls out at 2 a.m. to use the bathroom. The highest-yield CNA response is to respond promptly, raise the bed only to transfer, apply gripper socks, lock the wheels, allow a brief dangle to prevent dizziness, and walk the resident with a gait belt - then return the bed to its lowest position with the call light in reach. Skipping the prompt response is what causes the resident to climb over the rail and fall, which is why answering the call light quickly is itself a fall-prevention intervention.
A resident begins to slide out of a chair toward the floor. What is the CNA's best action?
Which finding most increases a resident's fall risk?
Immediately after a resident is found on the floor, the CNA should: