Fall with Neuro Changes in LTC/SNF
Unwitnessed fall? Anticoagulants involved? Here's how to organize the provider call without spiraling.
You know the resident. Let us help organize the call.
A guided example for SNF, LTC, rehab, and assisted living workflows.
Fall · Neuro check
Mr. D · Rm 22A · 0317
Provider call ready
"Hi Dr. Patel — Mr. D in 22A, unwitnessed fall, on apixaban, new sluggishness. Update: I'd like to hold his apixaban and send him out for a head CT. Okay to go with that?"
What to have ready
Falls move fast. Having these details ready helps providers quickly determine next steps and transfer needs.
Witnessed vs unwitnessed fall
Exactly what was seen — or not seen
Time resident was found
Last known well + estimated time on floor
Neuro checks
GCS or AVPU + repeat q15-30min
LOC changes
Any loss of consciousness, even brief
Pupil assessment
Equal, reactive, any asymmetry
Anticoagulant status
Warfarin, apixaban, clopidogrel, aspirin
Pain complaints
Where, quality, worsening
ROM assessment
What they can move vs guarding
Skin tears or visible injury
Head, hips, wrists, ankles
Blood pressure
Trend + orthostatics if safe
Baseline mentation
What's normal for THIS resident
EMS status
On scene ETA or hold per provider
Code status
Confirm before transfer decisions
Having these details ready helps providers quickly determine next steps and transfer needs.
Unwitnessed fall · possible head injury
A realistic SNF/LTC example to show the shape of the call. Your resident won't read exactly like this — that's what Panic Mode is for.
Calling about Mr. D in Rm 22A — unwitnessed fall, found on floor by the side of the bed. New neuro changes since the fall.
78M, baseline A&Ox3, ambulates with rolling walker. Hx of Afib on apixaban 5mg BID, HTN, mild Parkinson's. No recent falls in the last 90 days.
Found on floor at 0315, estimated time on floor unknown — possibly 10-15 minutes. A&Ox2 now (baseline x3), sluggish to respond, pupils equal and reactive. Small hematoma left occiput, no laceration. BP 156/92, HR 88, T 98.4, SpO2 95% RA. Complains of mild occipital headache. Guarding left hip, limited ROM on passive movement.
Update: I'd like to hold his apixaban, send him out for a head CT, and get pelvic and left hip films. Should I hold his Parkinson's meds until neuro is cleared? And do you want EMS or facility transport?
This is one version of the call. Panic Mode rewrites it around your resident's vitals, history, and what changed tonight.
Build Your Own CallWord-for-word, calm under pressure.
The opening line is the hardest part. Here's one that works for a fall with neuro changes in LTC/SNF — adapt it to your resident, your unit, your provider.
After-hours call · 0320
"Hi Dr. Chen, this is Jordan, RN at Maplewood — quick SBAR on Mr. D in 22A.
He's a 78-year-old, baseline A&Ox3, found on the floor by the side of his bed at 0315. Unwitnessed fall, estimated time on floor about 10-15 minutes. Hx of Afib on apixaban 5mg BID, HTN, and mild Parkinson's. No falls in the last 90 days.
Currently A&Ox2, sluggish to respond — that's a change from his baseline. Pupils equal and reactive. Small hematoma on the left occiput, no laceration. Vitals: BP 156/92, HR 88, T 98.4, SpO2 95% on room air. He's complaining of a mild occipital headache and guarding his left hip. Limited ROM on passive movement.
Update: I'd like to hold his apixaban and send him out for a head CT, plus pelvic and left hip films. Should I hold his Parkinson's meds until neuro is cleared? And do you want EMS or facility transport?"
Tip: end with a clear question and the specific next steps. It's faster for them, and safer for him.
"Resident fell" isn't a chart entry.
Avoid charting simply "resident fell." Document the specific details that matter for both the provider and any subsequent review:
Instead of
"Resident fell tonight."
Try
"Unwitnessed fall, found supine on floor by side of bed at 0315. Small occipital hematoma, A&Ox2 (baseline x3), on apixaban. Neuro checks q15min initiated. Provider notified, head CT and hip films ordered. EMS transfer pending."
Don't wait on these.
If any of these show up after a fall with neuro changes, the call (and likely the transfer) shouldn't wait for a full work-up.
- Unequal pupils
- Vomiting
- Sudden lethargy
- Seizure activity
- Worsening confusion
- Anticoagulant use with head injury
- Loss of consciousness
- Acute BP instability
- New weakness
Trust the gut feeling. If something feels off — even before vitals confirm it — that's worth a call and likely a head-to-toe reassessment.
You've already done the hard part.
Less overthinking. More confident calls — built around your resident, not a template.