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Have a Plan to Prevent Patient Falls

By Collette Health


Patient falls continue to be a major problem for health organizations. The Agency for Healthcare Research and Quality (AHRQ) estimates that each year between 700,000 and 1 million people in the U.S. fall in hospitals. These falls can result in fractures, lacerations, or internal bleeding, which can lead to further healthcare utilization.

The AHRQ says close to one-third of falls can be prevented by managing a patient’s underlying fall risk factors and optimizing the hospital’s physical design and environment. It can be a complicated situation for healthcare staff when treating a patient for the problem that resulted in their admission, while also keeping the patient safe and helping the patient to maintain or recover physical and mental function, according to the AHRQ.

Underlying fall risk factors can include problems with walking and transfers, medication side effects, confusion, and frequent toileting needs. Fall prevention needs to be a team effort, with staff from multiple disciplines and teams involved in caring for the patient. Effective prevention requires an organizational culture and operational practices that promote teamwork and communication. The AHRQ says it’s important to balance fall prevention activities with considerations such as minimizing restraints and maintaining patient mobility to provide the patient with the best possible care.

The AHRQ’s Fall Prevention Toolkit breaks down fall prevention activities into separate steps:

  • Universal fall precautions
  • Standardize assessment of fall risk factors
  • Care planning and interventions that address the identified risk factors with the patient’s overall care plan
  • Post-fall procedures, including a clinical review and root cause analysis


Universal fall precautions

Universal fall precautions apply to all patients regardless of fall risk, according to the AHRQ. They center around keeping the patient’s environment safe and comfortable. Precautions may include the following:

  • Familiarize the patient with the environment.
  • Have the patient demonstrate how to use the call light.
  • Ensure that the call light is within the patient’s reach.
  • Keep the patient’s personal possessions within safe reach.
  • Have sturdy handrails in patient bathrooms, room, and hallway.
  • Place the hospital bed in low position when a patient is resting in bed, and raise it to a comfortable height when the patient is transferring out of bed.
  • Keep hospital bed brakes locked.
  • Keep wheelchair wheel locks in locked position when stationary.
  • Keep the patient in nonslip and comfortable footwear that fits well.
  • Use night lights or supplemental lighting
  • Keep floor surfaces clean and dry.
  • Keep patient care areas uncluttered.
  • Follow safety patient handling practices.


Standardized assessment of risk factors

Assessing a patient’s fall risks provides the information you need to put together an individualized care plan, says the AHRQ. There are multiple fall risk factors and different patients can have different combinations of risk factors, which can change during a patient’s hospital stay. To identify the most important risk factors to your patients, have a system in place to ask the same key questions of each patient so risks are not missed. This is best done through a standardized assessment of risk factors.

This standardized process uses an assessment tool to evaluate several different dimensions of risk, including fall history, mobility, medications, mental status, and continence. Key risk factors common to assessments include:

  • History of falls: All patients with a recent fall history, such as in the past three months, should be considered at a higher risk for falls.
  • Mobility problems and use of assistive devices.
  • Medications: This includes patients on a large number of prescription medications or patients taking meds that could cause sedation, confusion, impaired balance, or orthostatic blood pressure changes.
  • Continence: Patients who have urinary frequency or have frequent toileting needs.
  • Other risks such as being tethered to equipment that could cause the patient to trip; vision impairment; and orthostatic hypertension, which could cause lightheadedness or fainting.


Care planning

Once you’ve identified patient risk factors, care planning should match the identified risks. This includes planning for any risks found on the risk factor assessment tool, such as mobility challenges, medications, mental status, and continence needs. It also includes planning around risks that may not have been captured by the assessment tool.

The care plan includes specific actions that should or should not be performed. All care planning needs to be individualized to fit the patient’s needs, and each risk factor should have a corresponding plan of care.


Post-fall clinical review

No matter how much prevention planning you do, patients will still fall. When a fall happens, carefully assess the patient for any injuries. After the patient is treated, you must document your findings in the medical record and complete an incident report. In addition to doing a careful clinical review for injuries, you should conduct a root cause analysis to understand the causes of the fall.


For more information on comprehensive fall prevention strategies, see PSQH’s Health Risk Management Week Special Report, co-sponsored by Collette Health.