Falls in hospitals can have a highly detrimental impact on patients, their loved ones, and the healthcare facilities where these events occur. To minimize the frequency of patient falls and mitigate the severity of potential fall-related injuries, hospitals must develop, implement, and continually strive to improve multifaceted fall prevention programs that are tailorable to individual patients’ needs.
Falls prevention in hospitals begins with leadership and staff recognizing the importance of actively committing to such a program. Another early imperative is understanding what can cause a patient under care at the facility to suffer a fall in the first place.
Causes of falls can be divided into three categories: anticipated physiological falls (e.g., unstable gait, high-risk meds, altered mental status, frequent need for toileting), which account for the majority of hospital falls; unanticipated physiological falls (e.g., seizure, stroke); and accidental falls, which are attributable to environmental hazards.1,2
Regardless of their specific causes, patient falls in U.S. hospitals are an all-too-common problem, as underscored by the statistics presented in the graphic below.
Injuries resulting from patient falls represent a serious challenge for hospitals and other care facilities. Data published by The Joint Commission, for example, indicate patient falls were the most prevalent sentinel event type voluntarily self-reported to TJC by accredited or certified entities in 2022, marking the fourth consecutive year patient falls have topped the list.3 In addition to physical harm, of course, patient falls in hospitals can also impose severe emotional and financial hardships on patients and their families.
It should be noted that patient falls have significant financial consequences for healthcare systems, too, with one large-cohort study reporting that the average total cost of a fall was $62,521 ($36,776 direct costs) and that the average total cost of a fall with any injury was $64,526. 4
When assessing an individual’s risk for falls, clinicians should be aware of the most common fall risk factors. According to a systematic literature review of patient falls in hospitals, the following set of risk factors repeatedly emerged as significant:5
Falls history ― a patient with a previous history of falling
Gait instability ― a patient with an unstable gait
Lower limb weakness ― a patient with lower limb weakness or fatigue
Urinary incontinence ― a patient with urinary incontinence, a patient who has to urinate frequently, or a patient who requires assisted toileting
Agitated confusion ― a patient who is agitated, confused, or whose judgment is impaired
Certain medications ― a patient who has been prescribed certain drugs, particularly sedative hypnotics
Staff should also keep in mind that although falls are not a normal part of aging, they are the leading cause of injury and injury death among U.S. adults 65 and over.6
Fall prevention programs in hospitals commonly incorporate several components, each of which serves an essential purpose:
Universal fall precautions, which are basic safety measures that apply to all areas of the hospital, include practices such as hourly nurse rounding protocols, regularly scheduled environmental inspection rounds, the use of hazard report forms, and training for safe patient handling.1
The next step in falls prevention, standardized assessment of fall risk factors, involves the use of a fall risk assessment tool and aids in clinical decision-making, targeting of preventative interventions to the appropriate patients, care planning, and effective communication between healthcare professionals and settings.1
Ultimately, care planning for falls prevention must take into consideration the patient’s unique risk profile, including any personal risks that might not have been captured by the fall risk assessment tool, and be integrated with the care that is being provided for the condition that caused hospitalization.1
However, even with sensible fall prevention measures in place, patient falls are difficult to eliminate completely. Useful post-fall procedures include clinical reviews (to identify post-fall injuries or other complications) and root cause analysis (to understand what problems contributed to the fall).1
Correct use of the right technology can improve an organization’s fall prevention program. Today, hospitals and care facilities are able to choose from a wide range of medical devices that have been engineered to help prevent falls and/or fall-related injuries. These offerings include impact-absorbing floor cushions, impact-absorbing hip pads, and wired or wireless fall monitoring alarms, sensors, and nurse call adapters.
The most recent additions to this list, wireless fall monitoring alarms, sensors, and nurse call adapters, represent an innovative technology that helps nurses monitor fall risk patients who may attempt an unassisted chair or toilet exit. Use of this technology is intended to complement, not supplant, key protocols such as nurse rounding and assisted toileting.
The flexible placement of wireless fall monitoring alarms and sensors within the care environment, along with their simple compatibility with the hospital nurse call system, accommodates nursing workflow and can help these busy professionals use their time more efficiently.
Creating a culture of awareness and accountability is paramount to successful falls prevention in hospitals. The efficacy of a fall prevention program can be strengthened by empowering nurses, educating all staff, and encouraging communication between staff members, patients, and family.
One way to facilitate cultural change would be to permit registered nurses to perform fall and fall-injury risk assessments upon admission, empowering them to leverage the full extent of their expertise by applying elements of the nursing process (i.e., assessment, diagnosis, outcome identification, and evaluation) to bolster falls prevention efforts.7
Another way to promote a culture of safety is to educate all staff regarding the importance of falls prevention and the means by which they can help reduce falls and fall-related injuries. Staff should understand the rationales for the fall prevention program as well as receive appropriate levels of training on the strategies, protocols, and technologies to be implemented at the facility.
And, finally, clear communication amongst staff members, patients, and families also helps engender a culture of safety. Patient-specific care plans, for instance, which are active documents created to ensure continuity of care by all staff members, can not only help keep the patient safe and comfortable but can be utilized to educate both the patient and their family before discharge.1
Interested in learning more? Contact us to discuss patient falls prevention!