How to report and review falls
Short answer
Report every fall, with or without injury. CMS counts a resident found on the floor as a fall. Record time, place, activity, footwear, call light and medication changes, screen unwitnessed falls with injury, and review patterns.
What counts as a fall?
Report every fall, injury or not. CMS's F689 guidance defines a fall as unintentionally coming to rest on the ground, floor or other lower level, not from an overwhelming external force. A resident found on the floor counts as fallen unless evidence shows otherwise.
A near-fall counts too: the resident lost balance and would have fallen without help. The CDC reports over 14 million older adults, about 1 in 4, report falling each year (2020-2021 data). Falls are the leading cause of injury for adults 65 and older.
What to do in the first hour
Treat, notify, preserve the facts, report the same shift, screen unexplained injury.
- Assess and treatCall for help. Do not move a suspected injury until assessed.
- NotifyTell the physician and the family or representative, per policy and state rules.
- Preserve the scene factsNote floor, lighting, bed height, brakes, alarms, footwear and equipment.
- File the report before shift endDetails fade fast.
- Screen the injuryIf no one saw how it happened, use the unknown-source test below.
What to record
Record the circumstances that explain the fall, as facts.
| Field | Why it matters |
|---|---|
| Time, place, activity (toileting, transfer, walking) | CMS names time of day and location as trends. |
| Witnessed or found | Unwitnessed falls need extra screening. |
| Injury and treatment | Sets severity and who must be told. |
| Footwear, lighting, floor, equipment, alarms | Hazards the facility controls. |
| Call light, last toileting, rounding | Shows supervision level. |
| Recent medication or condition changes | A common contributing factor. |
| Care plan interventions in place | Shows if planned steps were used. |
| Changes made after the fall | Links the fall to the care plan. |
Write facts and conditions, not judgments
Compare these two entries for the same event.
| Weak | Strong |
|---|---|
| Resident found on floor. No injury. Resident non-compliant with call light. | Found on floor beside bed at 05:40, not witnessed. Says she was going to the bathroom. Call light clipped to rail, out of reach. Bed high. Non-slip socks on. Last toileting offered at 02:00. No injury. Physician and daughter notified at 06:05. |
The second entry names three fixable conditions: call light, bed height, toileting schedule.
Unwitnessed falls and injuries of unknown source
An injury of unknown source meets all three CMS conditions: no one saw the cause, the resident cannot explain it, and the injury is suspicious by extent, location or number. Treat it as an alleged violation.
Then the clock starts: immediately, and within 2 hours if abuse is alleged or the event causes serious bodily injury, otherwise within 24 hours (42 CFR 483.12(c)(1)). See abuse reporting deadlines.
Review the pattern, not just the fall
F689 asks for four steps: identify hazards, evaluate them, put interventions in place and monitor whether they work. Review prior accidents, root causes, time of day and location. Include nursing, therapy, pharmacy and maintenance.
- Group falls by unit, room, shift and hour each month.
- List repeat fallers and check their interventions were in place.
- Compare falls with and without injury.
- Take patterns to the QAPI committee (the quality program CMS requires). Nursing homes must track adverse events and analyze causes (42 CFR 483.75(e)(2)).
The same fields work in hospitals and for employees. For a worker's fall on a plant floor, swap the care plan for surface, footwear, housekeeping and ladder use. See workplace injury reporting.
Mistakes to avoid
These habits hide patterns.
- Reporting only falls with injury.
- Blaming the resident. Ask what the system missed.
- Re-education as the only action.
- Skipping the screen for unwitnessed falls with injury.
- Care plan changes not linked to the fall.
- Leaving the narrative to the next shift.
- Treating hospital and plant falls as different.
How IncidentKit changes the job
Staff text the fall. Lauren asks the follow-up questions a risk manager would ask and fills the form. A person reviews and signs. Routing can alert the administrator.
The fall links to its investigation and corrective actions, each with an owner, due date and effectiveness check. Analytics show patterns by unit and shift.
The parts of IncidentKit behind this
- Incident reporting: The full record holds who, what, where, harm, evidence and what happens next.
- Lauren, the AI assistant: Tell Lauren what happened. She asks, fills the form, and a person signs.
- Routing and escalation: Severity decides who gets paged, and it escalates if nobody acts.
- Investigations and RCA: A guided investigation: find causes, pick a disposition, and a person signs.
- Corrective actions (CAPA): Every fix has an owner, a date and proof. Unverified fixes keep it open.
- Analytics: See which rooms, shifts and equipment keep showing up in your incidents.
Frequently asked questions
Does a fall without injury need an incident report?
Yes. A fall without injury is still a fall under CMS's F689 guidance, and it shows the hazard before anyone is hurt.
How soon after a fall should the report be filed?
Before the shift ends; your policy sets the exact time. An injury of unknown source can start the 2- or 24-hour abuse clock on its own.
What falls data should go to the QAPI committee?
Falls by unit, time of day and location, with and without injury; repeat fallers; and whether post-fall interventions were in place. Nursing home QAPI must track adverse events and analyze their causes (42 CFR 483.75(e)(2)).
Are hospital falls handled the same way?
Mostly; the fields are the same but the rules differ. F689 is a nursing home tag. Hospitals follow their own QAPI condition (42 CFR 482.21), and your state and accreditor may add reporting rules for falls with serious injury.
Sources
- CMS: State Operations Manual Appendix PP, F689 accidents and F609 injuries of unknown source
- eCFR: 42 CFR 483.25(d), accidents
- eCFR: 42 CFR 483.12(c), response to allegations
- CDC: Older adult falls data
- eCFR: 42 CFR 482.21, hospital QAPI
Reviewed against the sources above on Oct 5, 2026. Rules change: confirm current requirements with the issuing body or your counsel before relying on any summary.
Start with one incident.
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