Patient Fall Response

Steps

• Don't move patient if injury suspected
  Pause. Assess for obvious injury (deformity, LOC, severe pain, head strike). If c-spine injury possible, immobilize and call rapid response.
• Vital signs + neuro check
  Full vitals. GCS. Pupil check. Strength bilateral. Document baseline and re-check in 15 min.
• Notify provider
  Call attending/hospitalist. Use SBAR. Capture orders (imaging, labs, observation level).
• Notify family
  Per facility policy. Be factual. Document call: who notified, what was said.
• Document fully
  Fall narrative: time, location, witnessed/unwitnessed, suspected cause (lost balance, syncope, trip). Update fall risk score and prevention plan.
• Post-fall huddle
  Charge + RN + PCT + (if available) physical therapy. Identify root cause and update plan-of-care prevention measures.