Reducing Falls in Hospitals: A Practical Guide

Reducing the Risk of Falls in Hospitals: A Practical Guide

Falls can cause significant injury and are a pressing concern in hospital settings. However, there are many evidence-based fall prevention strategies that hospitals can implement to reduce risk. This comprehensive guide outlines practical tips, protocols and programs for decreasing falls and promoting safety.

The Serious Impact of Hospital Falls

Falls are the most common accident in hospitals. Approximately 250,000-700,000 falls occur in U.S. hospitals every year. Up to 30% of patients fall at least once during their hospital stay. Falls often lead to injury, with up to 10% causing serious harm like fracture, laceration or head trauma. They can also increase length of stay and care costs. Ultimately, falls diminish quality of life and independence.

Certain factors increase fall risk in hospitals like having impaired mobility, dizziness, needing toileting assistance, and taking high-risk medications. Advanced age, dementia, and having a history of falls also heighten risk.

Because the consequences can be so severe, fall prevention needs to be a top priority. When hospitals implement thoughtful protocols, programs and environment design, they can meaningfully reduce accidents and enhance patient safety.

11 Effective Ways Hospitals Can Prevent Patient Falls

Here are some of the most important evidence-based strategies hospitals should employ to reduce falls:

1. Fall risk assessment - Assess all patients on admission and regularly using a validated tool like the Morse Fall Scale.
2. Care planning - Develop an individualized fall prevention care plan for at-risk patients. Integrate across staff.
3. Patient education - Educate patients and families on fall prevention strategies and unsafe behaviors to avoid.
4. Signage - Use signs, wristbands, and door magnets to identify high fall risk patients.
5. Footwear - Provide non-slip socks or rubber-soled shoes for patients at risk.
6. Ambulation assistance - Have staff assist with walking and transport. Educate on proper use of mobility aids.
7. Medication review - Identify and minimize use of medications that increase falls.
8. Bathroom safety - Install grab bars, nightlights, toileting aids such as raised toilet seats.
9. Bed alarms & monitoring - Use alarms and checks to alert staff if a patient at risk gets up.
10. Environment design - Increase lighting, remove clutter, have handrails in halls, no-slip flooring.
11. Post-fall analysis - Review circumstances after any fall to identify causes and needed improvements.

This multi-faceted approach focuses both on the patient and on the surrounding environment to minimize fall opportunities.

Creating Effective Fall Prevention Protocols

To ensure consistent and effective practice, hospitals should develop detailed fall prevention protocols and policies. These should clearly define:

• The fall risk assessment process and tools to be used
• When assessments will be done (e.g. at admission, daily, after a fall, before ambulating)
• Who will complete assessments (e.g. RN, PT)
• Protocols for communicating risk level across staff
• Specific interventions to be implemented for varying risk levels
• What patient and family education is needed
• How the prevention plan will be integrated into the care plan
• The post-fall review process to identify causes and improvements

Protocols should be evidence-based and developed by a cross-functional team. Ongoing auditing of protocol adherence and fall outcomes will help sustain and improve practices.

Best Practices for Assessing Fall Risk

Thorough, routine assessment of fall risk is the essential first step. Assessment should:

• Occur on admission, daily, and after any fall
• Use a validated risk screening tool (e.g. Morse Scale)
• Review medications and medical conditions that increase fall risk
• Include physical exam of vision, mobility limitations, dizziness, and more
• Evaluate toileting needs and cognition
• Identify any history of falls

Nurses are often the professionals conducting assessments, but it is ideal to have a collaborative team approach with input from physicians, therapy staff and the patient and family.

Creating Individualized Fall Prevention Care Plans

The next vital step is using assessment findings to create a tailored fall prevention care plan integrated into the overall care plan. This should outline:

• The patient's specific fall risk factors
• Measures to address those risks (e.g. assistance ambulating)
• High-risk medications to be minimized or changed
• Aids to be used (e.g. bed alarm)
• Safety education provided to patient and family
• Other precautions specific to the patient's needs and risks

Care plans will evolve as the patient's status changes. Update and reassess regularly.

Providing Effective Patient and Family Education

Educating patients and families is critical for fall prevention. Education should cover:

• The patient's fall risk factors
• How the fall prevention plan will address those risks
• Alarm use and purpose of any aids or restraints
• Importance of asking for help with ambulating
• Unsafe behaviors to avoid like climbing over bedrails
• How to use call light for assistance
• Hazards to avoid like wet floors or poor lighting

Provide handouts, demonstrate proper use of aids, have patients repeat back instructions, and remind regularly. Obtaining patient and family buy-in improves plan adherence.

Using Technology & Design to Prevent Falls

The physical environment plays a big role in fall prevention. Strategies include:

• Handrails in halls and grab bars in bathrooms
• Proper lighting including nightlights, glow strips and well-lit pathways
• No-slip flooring and keeping floors dry
• Beds, chairs and toilets at proper heights
• Bed and chair alarms
• Non-slip socks and mobility aids
• Elevated toilet seats, shower chairs, and other aids
• Removal of unnecessary clutter and tripping hazards

Using technology like sensor tracking systems, video monitoring, or wearable alarm devices may also help alert staff early if a patient at risk is attempting to get out of bed or ambulate alone.

Training Hospital Staff on Fall Prevention

Staff education is essential for creating a culture of safety around falls. Training should cover:

• Fall risk factors, screening, and assessment protocols
• Strategies for reducing risk like safe patient handling techniques and medication management
• Use of alarms, mobility aids, and other fall prevention tools
• Importance of routine toileting assistance
• How to integrate and communicate about fall prevention plans
• How the environment impacts risk

Require regular competency assessments. Ensure adequate staffing levels to properly implement protocols. By making fall prevention a hospital-wide priority through training, better outcomes result.

Implementing Fall Prevention Programs

Comprehensive fall prevention programs that pull all these strategies together can significantly reduce rates. Programs should:

• Have leadership support and a coordinated effort
• Outline specific protocols, tools and procedures
• Identify a fall prevention committee or coordinator
• Require staff training on assessments, care planning and environment design
• Outline how risk levels will be communicated across staff
• Have procedures for post-fall analysis and continuous improvement
• Include patient and family education

Programs allow hospitals to take a systematic approach to identify risks and consistently implement best practices.

The Bottom Line

Falls can seriously injure hospital patients and prolong recovery. But a multi-faceted approach addressing risk factors, care planning, patient education, staff training, environment design and program coordination can significantly prevent accidents and enhance safety. Falls are not an inevitable part of hospitalization. By making fall prevention a top priority, hospitals can greatly reduce risks and improve outcomes.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.