7 Strategies for Fall Prevention in Healthcare

Prioritizing fall prevention is essential in healthcare, as patient falls represent the most frequently reported adverse event in hospitals. These incidents not only pose a severe public health risk but contribute to poor clinical outcomes, diminished quality of life for patients, extended hospital stays, and inflated healthcare costs. Given these impacts, creating and implementing robust fall prevention strategies is imperative.

Read on for insights into various evidence-based approaches for fall prevention, and how to effectively integrate these strategies into your organization's practices. 

Understanding Types of Falls

Understanding the different types of falls and their associated risks is crucial for implementing effective fall prevention strategies. Additionally, certain disorders can lead to unexplained falls, further emphasizing the need for comprehensive understanding and management of these conditions.

Accidental Falls

Accidental falls are the second leading cause of unintentional injury deaths worldwide, with adults older than 60 years of age suffering the greatest number of fatal falls. Accidental falls are also the most common cause of injury in children and people with low muscle strength.

A variety of factors can contribute to accidental falls, such as:

• Slippery or uneven surfaces
• Inadequate lighting
• Obstacles or clutter in walking areas
• Improper use of assistive devices (like walkers or canes)
• Medication side effects that affect balance or coordination
• Vision or hearing impairments
• Muscle weakness or poor physical condition
• Cognitive impairments, such as dementia

Anticipated Physiological Falls

Anticipated physiological falls are those that occur due to expected physiological factors such as unstable gait, a history of falling, altered mental status, frequent toileting needs, and certain medications. These falls are predictable and often related to underlying medical conditions.

Unanticipated Physiological Falls

Unanticipated physiological falls are caused by unexpected physiological factors such as seizures, syncopal episodes, and delirium. These falls cannot be predicted and comprise about 8% of all falls.

Intentional Falls

Intentional falls, often associated with trauma, can occur due to a variety of reasons, including intentional self-harm. These falls often result in severe injuries requiring emergency care and the involvement of multiple healthcare professionals.

Risk Factors for Falls

Falls are a common concern in healthcare settings, with rates ranging from 2.6 to 7 per 1000 patient days. They can lead to serious injuries such as fractures, lacerations, or internal bleeding.

Risk factors for falls include:

• Advanced age, particularly individuals over 80 years
• History of previous falls
• Impaired balance
• Reduced muscle strength
• Visual impairments
• Gait difficulties
• Depression
• Dizziness or vertigo
• Functional limitations
• Cognitive issues, including dementia and Parkinson's disease
• Environmental hazards, such as:
  • Slippery or uneven surfaces
  • Cluttered walking areas
  • Poor lighting
  • Inappropriate footwear
  • Step hazards
  • Unsafe handrails
  • Loose mats or rugs

Each year, between 700,000 and 1,000,000 people in the United States experience a fall in the hospital. However, research indicates that close to one-third of these falls can be prevented through the management of a patient's underlying fall risk factors and optimizing the hospital's physical environment.

Seven Strategies for Reducing Fall Incidents

1. Risk Assessments

Fall risk assessments are crucial in identifying individuals at risk of falling. Customizing prevention based on risk profiles involves identifying key risk areas, understanding the organization's risk tolerance, and the ability to mitigate risks. This involves multiple tests to identify risk factors such as the ones listed above. Guidelines recommend annual screening to identify patients at increased risk of falling and management of modifiable fall risk factors for high-risk patients.

2. Care Plan Customization

In the context of fall prevention in healthcare, adapting plans to individual needs involves a multifaceted approach. This includes patient education, environmental adaptations, physical activities, diet, and medication monitoring. It is recommended to implement an individualized and collaborative care plan to address identified risk factors, which may include ensuring a safe environment and making appropriate referrals. Furthermore, it is crucial to engage older people in fall prevention exercises, as their involvement can significantly contribute to the effectiveness of the interventions.

3. Environment of Care Rounding

Purposeful and timely rounding is a best practice intervention to meet patient care needs, ensure patient safety, and decrease the occurrence of patient-preventable events, including falls. The Institute for Healthcare Improvement endorses as an effective method to reduce fall injuries. Regular checks for safety hazards for fall prevention during rounding can eliminate possibilities for falls. Staff engagement in identifying risks for fall prevention is crucial in both healthcare and workplace settings.

4. Staff Training

Educating staff on fall prevention and patient support can help them understand what to look for and be prepared in the event a fall occurs. The Agency for Healthcare Research and Quality (AHRQ) provides a comprehensive training program that helps hospitals understand the components of a fall prevention program and how to overcome challenges associated with its development, implementation, and sustainability. The training program emphasizes the roles and responsibilities of different staff members, including nurses, physical therapists, and pharmacists, in preventing falls.

5. Rehabilitation and Exercise

Exercise plays a significant role in fall prevention in hospitals, particularly among older adults. It can reduce the risk of falling by improving balance, increasing muscle strength and flexibility, and enhancing body mechanics. Different types of exercises, such as the sit-to-stand exercise and Tai chi are effective in reducing fall risks. A systematic review found that exercise as a stand-alone intervention strategy can reduce the rate of falls by 23%.

6. Incident Management Software

Incident management software can optimize fall prevention strategies by improving incident prevention capabilities and enabling quick responses to potential incidents. These tools can help in identifying and analyzing hazards and risks, thereby aiding in the development of effective mitigation strategies and controls to prevent recurrence. Implementing incident management software that provides real-time incident tracking and trend analysis is crucial. They allow for the immediate identification of the most reported issues, enabling organizations to focus on these areas for improvement.

7. Education of Patients and Families

Patient education is an essential part of fall prevention strategies, as it aims to improve patient knowledge about falls and their risks and to teach patients and their caretakers about fall mitigation. It is important to ensure that patients and their families understand the patient’s fall risk and how the proposed care plan addresses these risks.

Fall prevention education can be delivered through various methods, such as direct face-to-face patient education, educational tools, and patient-focused materials like pamphlets, brochures, and handouts. The Centers for Disease Control and Prevention provides a variety of resources that can be used for fall prevention education, including a brochure and fact sheet.

Success Stories of Fall Prevention in Healthcare

Fall prevention strategies in healthcare often involve a combination of patient education, clinician education, environmental modifications, and system-level changes. A study published in The Journal of Patient Safety found that including safety practices in performance reviews and providing feedback to healthcare providers can effectively change provider behavior and potentially reduce falls.

The use of a patient-centered fall prevention kit, which provides care team members with the information they need to engage in the fall prevention program, has been shown to reduce patient falls by 25%.

Another successful case study of a fall prevention program is the Fall TIPS Program, which was implemented in 14 medical units within three academic medical centers. The program resulted in a 15% reduction in overall inpatient falls and a 34% reduction in injurious falls. The benefits of the program also extended to cost savings associated with fall prevention in healthcare .

Continuous improvement in fall prevention should be a priority in healthcare settings, as falls remain a common and debilitating problem. The use of technology can further prevent patient falls in healthcare by predicting potential fall risks and enabling proactive intervention.

Patient safety programs, including fall prevention strategies, are effective when there is strong leadership and commitment from the hospital. It is crucial to develop and implement evidence-based fall prevention strategies that are both effective and cost-efficient.

Ready to Get Started?

To reduce the number of falls occurring in healthcare, every stakeholder needs to take action. Healthcare providers need to assess and improve their fall prevention practices. Families and caregivers need to be proactive participants in ensuring measures that help to reduce falls. Patients need to actively engage in the prevention strategies that are set out for them.

To learn more about how Performance Health Partners’ incident management and rounding software can help reduce falls at your facility, schedule a call today.