According to the Agency for Healthcare Research and Quality, approximately 700,000 to 1,000,000 people fall in United States hospitals every day. (1) Patients aged 85 and older as well as those who have undergone recent surgery are more likely to be seriously injured if they fall.
More than one-third of in-hospital falls result in injury, including serious injuries such as fractures and head trauma. (1)
In addition, an estimated $50 billion per year is spent on medical care related to falls. (2)
These fall-related injuries can often lead to longer hospital stays (up to 12 additional treatment days), surgery, or even death. Those who are not physically injured from a fall may even develop a lack of confidence or fear of falling that decreases mobility. (3)
Quality improvement programs can drastically reduce fall risk in the hospital setting. The Mercy Health-Anderson Hospital medical/surgical unit in Cincinnati was able to reduce its fall rate from 10 falls per 1,000 patient days to two falls per 1,000 patient days over three years through a quality improvement program called Transforming Care at the Bedside, an initiative that focuses on improving care on medical and surgical units. (4)
"The med/surg unit is kind of the unsung hero. It's the backbone of the hospital in many ways, but there's not always a lot of focus on [its] operations. The goals of the TCAB program were to transform leadership, retain and engage med/surg nurses, improve quality of care on med/surg units, make care more streamlined and efficient and improve the patient experience with a real focus on everything being patient centered." -- Terri Martin, RN, BSN, MBA, Clinical Director of Anderson Hospital and TCAB program leader (4)
Healthcare organizations who are looking to improve upon their fall prevention procedures should consider implementing the following quality improvement strategies:
1. Assess each individual patients’ risk for falling
Fall risk screening should be conducted at every admission to determine which patients are considered high-risk for falling. Many factors can increase a patient’s risk for falling (5):
- Illnesses that cause weakness
- Medicines that cause dizziness
- New or unfamiliar environments
- Lack of activity
Another best practice is to use visual cues, such as red socks or color-coded armbands, to help staff recognize patients who have a high risk of falling at a quick glance. Through such visual cues, staff can quickly initiate the correct protocols and procedures to reduce fall risk. (6) The American Hospital Association recommends that healthcare facilities standardize colors to avoid confusion, indicating yellow as the color for falls risk. (7)
2. Patients should follow a mobility plan
Following a mobility plan keeps patients safe by helping them remain active and moving. (8) Increased strength leads to increased stability. When appropriate, patients should have frequent access to exercise with physiotherapists.
3. Caregivers should be in arms-reach when patients attend the restroom
Following a toileting schedule helps ensure that a staff member is always present when using the restroom. Grab bars should be used in restrooms as an additional tool for assistance when sitting down and standing up. (8)
Over 34% of patient falls are related to toileting with at least 44% of these falls occurring during the night. (9)
4. Provide safe footwear rather than just advising it
Facilities should provide easy access to non-skid footwear such as rubber-soled slippers or socks with grips for all patients prone to falling. (8)
5. Use bed alarms
Bed alarms can be used to alert staff whenever a patient at high risk for falls leaves their bed. (6) Healthcare workers must be responsive to alarms for these devices to be effective. An alarm should be used only if it makes sense for the individual patient to avoid unnecessary errors. (9) If used, the bed alarm's time interval should be no more than one or two seconds between the time a patient leaves the bed and the time the alarm sounds — otherwise, the patient could be halfway down the hall before it rings. (6)
6. Conduct regular safety rounding
One of the most effective strategies to prevent falls is conducting safety rounds on high fall-risk patients in addition to regular hourly rounds. During the safety rounds, a staff member should attend to basic needs such as assessing patient’s pain, bed position, and need to visit the restroom. Staff should also make sure that all precautions to prevent falls are in place, and that the environment is uncluttered and assistive devices are within reach. (10)
7. Review and/or discontinue medications associated with high-risk of falls
Psychoactive medications such as benzodiazepines can increase a patient’s risk of fall by nearly 47%. (10) It is important that healthcare providers routinely review medication side effects and work with pharmacists to develop a management plan to reduce fall risk, especially in older adults.
8. Provide easy access to mobility aids
Offering a hand for support is a simple test to determine whether a patient needs a gait aid. For these patients, a cane or wheeled walker can significantly reduce the risk of falling. (11)
9. Keep patients busy
Giving patients different activities to do helps them stay occupied and are therefore less likely to get out of bed. (6) Staff can encourage patients to practice exercises that they can do while lying in the hospital bed – this has a double benefit of keeping patients engaged as well as building up strength and muscle, which can help in fall prevention.
10. Implement a software solution for safety rounds
A technology solution can help care providers document previous fall history and assess this information to define departmental areas of improvement. Rounding tools make it simple for staff members to proactively address patient needs and environmental concerns and correct any deficiencies prior to a fall occurring.
Performance Health Partners Solutions
Performance Health Partners helps healthcare organizations provide the highest quality care in the safest possible environment. Our Incident & Event Reporting solution helps care teams proactively identify fall and other patient safety risks to get ahead of incidents before they happen. To learn more, visit performancehealthus.com or schedule a demo.