Fall prevention programs are multifaceted initiatives designed and implemented by hospitals and other healthcare facilities to reduce the occurrence of patient falls and mitigate fall-related injuries.
Patient falls represent an ongoing problem that must be dealt with more effectively, a situation borne out by recent data from The Joint Commission (TJC).
In 2022, for the fourth year in a row, patient falls were the leading sentinel event type voluntarily self-reported to TJC by accredited or certified entities.1 And, unfortunately, TJC data for the first half of 2023 indicate the continuation of the trend.2 Note that TJC defines a sentinel event as “a patient safety event that results in death, permanent harm, or severe temporary harm.”3
Nurses, in particular, play a vital role in falls prevention in hospitals. These knowledgeable professionals routinely shoulder many of the responsibilities associated with patient care and safety. Empowering registered nurses to conduct patient fall risk assessments can be one way to expand their role in fall prevention efforts.
Collectively, it is important for nurses to communicate and coordinate efforts relating to patient-specific fall care plans amongst all team members. Any changes to the plan should be documented and the up-to-date plan should follow the patient to new healthcare settings or facilities.4
Educating fall risk patients and their families is important, too. Nurses should review applicable safety measures with them in order to help prevent falls both during and after hospitalization.
Hospital patients find themselves in unfamiliar surroundings and have health conditions; therefore, many are at risk of falling.5 A broad range of additional biological, environmental, behavioral, and demographic factors can contribute to this risk.5
Factors that can contribute to falls include:
Organizations have a selection of screening and assessment tools at their disposal (e.g., the Morse Fall Scale and the Hester Davis Scale for Falls Risk Assessment). Such tools are intended to be used as just one component within an organization’s comprehensive fall risk screening and assessment process.4
When designing a program for falls prevention in hospitals and healthcare facilities, clinicians should be aware of potential mechanisms for patient falls. According to TJC’s annual review of their sentinel event data for 2022, the leading mechanisms for patient falls were ambulating, falling from bed, and toileting.1
Regarding the 2022 data, TJC also noted that, “Reported contributors to falls included policies not being followed (e.g., fall risk assessment), inadequate staff-to-staff communication during handoffs or transitions of care, and lack of shared understanding or mental model regarding plan of care.”1
A well-conceived program incorporates an array of fall prevention methods, strategies, and technologies that can be implemented to accommodate individual patients’ needs.
Nurses who provide care for fall risk patients must often contend with numerous daily challenges. One common barrier to falls prevention in hospitals is caseload (workload), or the number of patients whose care has been entrusted to each nurse. Staffing shortages, of course, can have an adverse effect on the nurse-to-patient ratio.
Another challenge to preventing falls in hospitals can be the dynamics of the patient population, an ever-changing group that often comprises individuals of various ages with unique medical conditions and needs. An additional barrier can be team communication, or the ability of caregivers to coordinate efforts and responsibilities clearly and consistently while working in a constantly evolving environment.
The reality of immediacy presents yet another challenge to falls prevention in hospitals. Unanticipated urgent events mean nurses may have to shift their focus at a moment’s notice to provide care when and where it’s needed the most. And lastly, physical items in the care environment (e.g., equipment cords or cables) can be a literal obstacle to falls prevention.
A wide range of tools can be used in fall prevention care planning for identified fall risk patients, including those discussed below.
Available technology solutions include wired fall monitoring alarms, sensors, and nurse call adapters designed to notify nurses if a patient attempts an unassisted bed, chair, or toilet exit. Recently, wireless versions of some of these devices have been introduced for use with fall risk patients who may attempt an unassisted chair or toilet exit.
Devices such as bed rails, bedside commodes, low beds, and floor mats can all play a role in keeping patients safe. These devices help reduce the risk of a fall or fall-related injury by either discouraging an unassisted bed exit, removing the immediate need to exit the bed, or facilitating assisted bed exits.
The installation of slip-resistant flooring can be helpful in reducing the risk of a fall. Meanwhile, brightly colored footwear, such as socks and slippers with nonskid soles or skid-resistant treads, can be used to identify fall risk patients.
Rooms should be laid out with patient safety and nursing workflow in mind. Environmental elements such as lighting, signage, positioning of beds and chairs, and placement of fall monitoring alarms and sensors merit careful consideration.
Effective toileting protocols help reduce the risk of falls not only in the bathroom but when the patient is seeking to ambulate to or from the bathroom. The practice of regular nurse rounding used in concert with a toileting schedule devised to meet each patient’s unique needs can help lessen fall risk.
Canes, walkers, wheelchairs, and scooters can help reduce risk of falls, provided the patient has received proper training and is able to demonstrate safe technique/operation.
Staff members must fully understand the hospital’s fall prevention protocols and guidelines. Simulated training scenarios can offer a particularly effective teaching method. Continuous staff education should include both new information and the review of previously learned material.
Healthcare staff should take time to educate patients and families on appropriate fall safety measures. Staff can utilize the patient’s individualized fall care plan to guide and reinforce these efforts.4
Among the most recent fall risk monitoring methods to be introduced are wireless alarms, sensors, and nurse call adapters. Designed to afford nurses greater flexibility when monitoring fall risk patients, they can often be placed more conveniently than their wired counterparts and do not introduce cords and cables (potential tripping hazards) into the care environment.
Use of these monitoring devices is intended to complement, not replace, an organization’s existing fall prevention protocols.
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