Jordan Ellis
Falls in hospitals are a common and debilitating problem worldwide, with more than 250,000 recorded annually in England and Wales alone. They are the most frequently reported safety incident, and can result in serious injury or even death, particularly for older patients. While not all falls are preventable, evidence suggests that 20-30% of falls can be prevented by assessing risks and intervening to reduce them. Hospitals have implemented various strategies to prevent falls, including non-slip socks, intentional rounding, bed or chair alarms, and patient education. However, the effectiveness of these strategies varies, and there is a need for continuous improvement to enhance patient safety and reduce the incidence of falls in hospitals.
| Characteristics | Values |
|---|---|
| Frequency of falls in hospitals | Very common, with more than 250,000 recorded annually in England and Wales |
| Severity of falls | 30–50% of falls result in physical injury, and 1–3% result in fractures. Falls can also cause psychological distress, fear, and loss of confidence. |
| Preventability | Falls are not true accidents and are preventable through a coordinated multidisciplinary clinical team approach. |
| Risk factors | Intrinsic (patient-related) and extrinsic (environmental) factors. Age is a significant risk factor, with older patients at higher risk. |
| Prevention strategies | Patient education, clinician education, environmental modifications, assistive devices, hospital systems, medication reviews, and risk screening tools. |
| Challenges | Insensitive risk screening tools, lack of staff engagement and leadership, and difficulties implementing complex interventions. |
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What You'll Learn
Effectiveness of fall risk screening tools
Falls in hospitals are the most frequently reported safety incident, with more than 250,000 recorded annually in England and Wales. 30-50% of falls result in physical injury, and 1-3% result in fractures. Falls are especially common in people aged 65 and older, and can cause serious injury.
Fall risk screening tools are frequently used to identify patients for intervention. However, existing tools do not have sufficient specificity and sensitivity to be effectively used in this population. The National Institute for Health and Care Excellence (NICE) guidelines recommend against the routine use of fall prediction tools, instead advising that all inpatients over the age of 65 be considered at high risk.
The Agency for Healthcare Research and Quality (AHRQ) suggests that it is more important to identify and address a patient's specific fall risk factors than to determine their risk for falling. For example, some medicines have side effects that cause dizziness, drowsiness, or confusion, which may increase the risk of falling. Other risk factors include poor lighting, loose rugs, and cords on the floor.
Despite the limitations of fall risk screening tools, they can still be useful in certain contexts. For instance, the Minimal Chair Height Standing Ability Test (MCHSAT) has been shown to have high sensitivity (75%) when administered in a standardized way, making it an appropriate tool for screening the risk of falling in healthcare settings.
Furthermore, the US Agency for Healthcare Research and Quality (AHRQ) has approved and recommended the use of the medication fall risk score (RxFS) in conjunction with various nurse-administered rating scales. The RxFS was developed as part of a pharmacist-coordinated falls prevention program in America to compensate for the lack of drug therapy risk assessment tools.
In conclusion, while fall risk screening tools may not be effective as standalone interventions, they can still play a role in identifying patients at risk of falling when used in conjunction with clinical evaluation and addressing specific risk factors.
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Patient education and engagement
Falls in hospitals are a common and serious problem, particularly for older patients. In England and Wales, falls are the most frequently reported safety incident in hospitals, with more than 250,000 recorded annually. 30-50% of falls result in physical injury, and 1-3% of falls cause fractures. Even without injury, falls can cause psychological distress, fear of further falls, and prolonged hospital stays.
One important aspect of patient education is ensuring that patients are aware of their risk of falling. Screening tools can be used to identify patients who are at high risk, and this information can be used to develop targeted prevention strategies. However, the available fall risk screening tools may not be sensitive enough to effectively identify patients at risk. Clinical judgement should also be used to assess a patient's fall risk, considering factors such as the patient's age, health conditions, and behaviour.
In addition to screening and assessment, effective patient education and engagement strategies are essential. This includes providing information and resources to patients and their families or carers. Simply providing a brochure on fall prevention is not enough; personal communication is essential. Patients should be encouraged to ask for assistance when needed and to use assistive devices if necessary.
There is also evidence that fall prevention interventions that incorporate educational theory and the principles of health behaviour change can be successful in reducing falls. These interventions should be tailored to the individual patient and their specific needs and goals.
By empowering patients with knowledge and resources, hospitals can help to reduce the risk of falls and improve patient safety.
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Staff training and leadership
Multiprofessional education and training are crucial to fostering positive attitudes towards fall prevention. Doctors of all grades and specialties play a vital role in reducing harmful events, especially in acute hospitals, as a significant proportion of emergency bed days are attributed to patients over 65 years of age. Leaders at all levels must promote a culture of safety consciousness through continuous feedback and learning from adverse events.
Staff training should focus on providing practical knowledge and skills to prevent falls. This includes understanding risk factors, implementing interventions, and utilizing assistive devices. For example, staff should be trained to identify patients at high risk of falling and develop tailored prevention strategies accordingly. Additionally, staff should be educated about the limitations of certain interventions, such as the questionable effectiveness of non-slip socks in preventing falls and their potential to spread drug-resistant infections.
Furthermore, staff training should emphasize the importance of patient education. Patients and their families should receive personalized fall prevention education, addressing their knowledge, perceptions, and goals. Encouraging patients to ask for assistance and providing easy access to necessary items can reduce fall risks.
Overall, effective staff training and leadership are crucial to establishing a culture of fall prevention in hospitals. By empowering staff with knowledge, skills, and positive attitudes, hospitals can significantly reduce the incidence of falls and improve patient safety.
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Environmental modifications
Firstly, hospitals should ensure easy access to essential items for patients. This includes items such as the TV remote control, glasses, magazines, and other objects that patients may need or prefer to have within reach. By providing easy access to these items, hospitals can reduce the risk of patients attempting to reach or move around without assistance and potentially losing their balance and falling.
Secondly, hospitals should consider the flooring and implement appropriate solutions to enhance traction and reduce slipping hazards. While non-slip socks are often provided to patients, research has questioned their slip-resistant properties, and they may even increase the risk of spreading drug-resistant infections. As an alternative, patients could be encouraged to wear their own non-skid footwear, such as slipper socks with non-skid treads, which can provide better traction and reduce the risk of falls.
Additionally, hospitals can utilise bed or chair alarms for patients who require supervision or assistance with mobilisation. These alarms can alert staff to a patient's movement, helping to prevent falls by ensuring timely assistance. However, it is important to note that alarms should not be relied upon as a single strategy, as they may not always be effective in preventing falls. Clinical judgement should be exercised when deciding to use these alarms, considering factors such as patient characteristics, staffing levels, and the potential for 'alarm fatigue' among staff.
Furthermore, hospitals should implement regular rounding or bedside checks to proactively meet patient needs. This involves staff conducting checks at regular intervals, typically every one to two hours, to ensure patients are safe and have what they need within reach. While this strategy may face challenges due to increased workload, staffing priorities, and documentation issues, it can still be an effective component of environmental modifications to prevent falls.
Lastly, hospitals should encourage a culture of safety consciousness through continuous feedback and learning from adverse events. By creating a vigilant safety culture, hospitals can identify potential environmental hazards and implement preventive measures to minimise the risk of falls. This includes addressing any environmental factors that may contribute to falls, such as ensuring proper lighting, removing clutter, and maintaining dry floors to prevent slipping hazards.
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Assistive devices
Falls in hospitals are a common and serious issue, particularly for older patients. They can cause injuries, fractures, and even result in death. To prevent falls, hospitals have implemented various strategies, including the use of assistive devices.
Hospitals should encourage patients to utilise these devices without feeling embarrassed or hesitant. By promoting a positive perception of assistive devices, hospitals can empower patients to take control of their safety and well-being. This shift in mindset can help patients understand that using these devices is not a sign of weakness but rather a proactive approach to fall prevention.
In addition to mobility aids, hospitals can provide patients with non-skid footwear or slipper socks with non-skid treads. While the effectiveness of non-slip socks in hospitals has been questioned, patients can benefit from using non-skid footwear at home to reduce their risk of falling. Bed and chair alarms are another type of assistive technology that can be considered for patients who require supervision or struggle to mobilise independently. However, it is important to note that alarms should not be solely relied upon, as they may not always prevent falls and can lead to "alarm fatigue" among staff.
By offering a range of assistive devices and educating patients about their benefits, hospitals can make a significant impact on fall prevention. Patients should be made aware that these devices are not restrictive but rather tools to enhance their safety and independence during their hospital stay.
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