Reducing Hospital Falls: Best Practices for a Safer Patient Environment

Introduction

Falls in hospitals remain a persistent challenge in healthcare, posing significant risks to patient safety and well-being. Not only can falls result in serious injuries, but they also contribute to extended hospital stays, increased healthcare costs, and diminished patient satisfaction. As healthcare professionals, it is everyone’s responsibility to implement evidence-based strategies to minimize fall risks and create a safer environment for patients.

Understanding the Problem

Before diving into solutions, it's crucial to understand the scope of the issue. According to the Agency for Healthcare Research and Quality (AHRQ), between 700,000 and 1 million patients fall in U.S. hospitals each year. Approximately 30-35% of these falls result in injury, with 11,000 falls leading to death. The AHRQ estimate that each fall with injury costs hospitals on average $6,694, with the 95%CI extending to $14,665. These statistics and associated costs underscore the urgent need for effective fall prevention strategies.

Best Practices for Fall Prevention

1.      Implement Interdisciplinary Team Rounds

One of the most effective strategies for reducing fall rates is the implementation of interdisciplinary team rounds. These rounds bring together professionals from various disciplines, including nurses, physicians, physical therapists, occupational therapists, and pharmacists, to collaboratively assess and address patient fall risks.

During these rounds, team members share their unique perspectives on each patient's condition, medications, mobility status, and environmental factors that may contribute to fall risk. This comprehensive approach allows for a more holistic view of the patient's needs and enables the team to develop tailored fall prevention plans.

Key benefits of interdisciplinary team rounds include:

·       Enhanced, focused communication among healthcare providers

·       Improved care coordination

·       Early identification of fall risk factors

·       Development of personalized fall prevention strategies

·       Increased accountability for implementing preventive measures

To maximize the effectiveness of these rounds, ensure they occur regularly (ideally daily) and involve active participation from all team members. Document the discussions and action plans in the patient's medical record for seamless communication across shifts.

The Westmead Hospital in Sydney, Australia, implemented twice-weekly Structured Interdisciplinary Bedside Rounds (SIBR® rounds) on two aged care units. Over three years and 3,673 patients, they reduced the incidence of falls by 30%, demonstrating the potential effectiveness of interdisciplinary collaboration through interdisciplinary rounds (IDRs). View the full case study here.

2.      Conduct Comprehensive Fall Risk Assessments

Implement a standardized fall risk assessment tool, such as the Morse Fall Scale or the STRATIFY tool, to identify patients at high risk for falls. Conduct these assessments upon admission, at regular intervals during hospitalization, and whenever there's a change in the patient's condition.

Ensure that all staff members are trained in using the assessment tool correctly and consistently. Use the results to guide individualized fall prevention interventions. Ensure staff understand the importance of the appropriate patient transfer technique following the risk assessment. Inform patients and families of the findings of the fall risk assessment and how they can contribute to safety, e.g. asking for assistance when moving.

3.      Enhance Environmental Safety

Environmental factors play a significant role in preventing falls. Create a safer physical environment by:

·       Keeping patient rooms and hallways clutter-free

·       Ensuring adequate lighting, especially at night

·       Installing handrails in bathrooms and along corridors

·       Ensuring call bells are within easy reach

·       Keeping beds in the lowest position when patients are resting, e.g. the use of low and ultra-low beds in at-risk populations such as aged care.

4.      Utilize Technology

There is a growing selection of technology to both monitor and alert staff to high-risk patients, such as:

·       Bed alarms and wearable technology to alert staff when high-risk patients attempt to get out of bed

·       Electronic health records to flag high-risk patients and track fall prevention interventions

5.      Implement a Medication Review Process

Many medications can increase fall risk due to side effects like dizziness or drowsiness. Implement a regular medication review process as part of the interdisciplinary team rounds. In high-performing units, this review can be shared forward to the care team during IDRs.

Consider:

·       Reducing or eliminating unnecessary medications

·       Adjusting medication timing to minimize side effects during peak activity periods

·       Exploring alternative treatments with lower fall risks

6.      Promote Mobility and Exercise

Encouraging safe mobility through physical therapy or tailored movement programs can help reduce falls. Nurses and therapists can collaborate to implement individualized mobility plans that allow patients to stay active without risking injury. Nurses and therapists can advocate for improved mobility, and pain management to facilitate this, during high-quality team rounds, e.g. during SIBR rounds.

·       Implement early mobilization protocols

·       Provide physical therapy and occupational therapy services

·       Encourage patients to participate in daily exercise programs, when appropriate and leverage family members to support this activity

7.      Monitor and Analyze Fall Data

Regularly collect and analyze fall data to identify trends and areas for improvement. Use this information to:

·       Adjust fall prevention strategies

·       Target high-risk areas or patient populations

·       Measure the effectiveness of interventions

The Accountable Care Unit (ACU® care model) clinical microsystem is an effective unit based governance model to align interdisciplinary teamwork on units. Fall data is typically reviewed between the unit-leadership dyad (nurse and physician co-leads) bi-weekly and also with peer unit leaders on a monthly basis.

8.      Foster a Culture of Safety

Promote a culture where fall prevention is everyone's responsibility:

·       Encourage staff to speak up about potential fall risks

·       Celebrate successes in fall prevention

·       Share lessons learned from fall incidents

Conclusion

Reducing fall rates in hospitals requires a multi-pronged approach that combines evidence-based interventions, interdisciplinary collaboration, and a commitment to continuous improvement. By implementing these best practices, hospitals can create a safer environment for patients, reduce the incidence of falls, and improve overall quality of care.

Remember, fall prevention is an ongoing process that requires dedication, teamwork, and adaptability.