Jordan Ellis
Falls are the most frequently reported safety incident in hospitals, with 30-50% resulting in physical injury and 1-3% causing fractures. As people age, the risk of falling and suffering a serious injury increases. Hospitals employ various guidelines to prevent falls, such as identifying high-risk patients and implementing prevention strategies. However, there is no standardized approach, and the effectiveness of certain methods, like alarms, is questionable. To reduce fall risk, hospitals can use visual cues, provide mobility aids, encourage physical activity, and address environmental hazards.
| Characteristics | Values |
|---|---|
| Identify patients at high risk of falling | Age, sex, history of recent falls, gait instability, agitation, confusion, new urinary incontinence, adverse drug reactions, neurocardiovascular instability |
| Fall risk screening | Conducted at every admission, visual cues such as red socks or color-coded armbands |
| Fall prevention strategies | Use of alarms, sitters, new systems and devices, exercise programs, assistive technologies |
| Fall prevention toolkits | Formal risk assessment and tailored plan of care, communication of patient-specific risk factors, environmental safety checklist, hazard report form |
| Interventions | Identification of underlying risk factors, clear interventions to reduce impact, universal interventions to reduce risk for patients, visitors, and staff |
| Staff considerations | Vigilant safety consciousness, continuous feedback and learning from adverse events, well-defined mobility plan, easy access to mobility aids |
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What You'll Learn
Identify patients at high risk of falling
Identifying patients at high risk of falling is a crucial step in fall prevention in hospitals. Falls are the most frequently reported safety incident in hospitals, and they can result in significant physical harm and reduced quality of life for patients. Therefore, hospitals should implement strategies to identify patients at high risk and develop targeted interventions to reduce fall risk.
One approach to identifying high-risk patients is through the use of fall risk prediction tools and risk assessments. These tools often consist of checklists of risk factors, such as advanced age (over 85 years), male sex, a recent fall, gait instability, confusion, and adverse drug reactions. While the effectiveness of these tools has been questioned, they can help identify patients with multiple risk factors who may benefit from targeted interventions.
Hospitals can also utilize universal interventions that focus on reducing risks in the physical environment and addressing how patients interact with their surroundings. For example, the Agency for Healthcare Research and Quality's Fall Prevention Toolkit provides checklists to identify and resolve environmental hazards, such as obstacles on the floor, that can contribute to fall risks for all patients, regardless of their individual risk factors.
In addition to environmental interventions, hospitals can implement strategies to enhance patient mobility and stability. This includes providing mobility aids, such as canes and walkers, to patients who need them and encouraging regular physical activity tailored to each patient's needs. Working with physiotherapists can help design specific exercises to improve balance and coordination, reducing fall risk.
Visual cues, such as colour-coded armbands, can also be used to quickly identify patients at high risk of falling. This allows staff to initiate the appropriate protocols and provide the necessary assistance to these patients.
By combining risk assessments, environmental interventions, mobility enhancements, and visual cues, hospitals can effectively identify patients at high risk of falling and implement targeted prevention strategies to reduce the incidence of falls and improve patient safety.
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Develop a tailored prevention plan
Developing a tailored prevention plan is a crucial step in reducing the risk of falls in hospitals. This involves implementing strategies that address the specific needs and risk factors of individual patients. Here are some key considerations for developing an effective prevention plan:
Firstly, it is essential to conduct a comprehensive risk assessment to identify patients who are at a high risk of falling. This includes evaluating a range of intrinsic and extrinsic risk factors. Intrinsic factors are related to the patient's health and include advanced age, male sex, a history of recent falls, gait instability, agitation, confusion, urinary incontinence, adverse drug reactions, and neurocardiovascular instability. Extrinsic factors are environmental and include obstacles, unfamiliar surroundings, and medication side effects. Tools such as the Fall Tailoring Interventions for Patient Safety (TIPS) Toolkit can assist in this process by providing a formal risk assessment framework.
Once high-risk patients have been identified, a personalized prevention plan can be developed. This may include providing mobility aids, such as canes or walkers, to improve stability and reduce fall risk. Ensuring that these aids are easily accessible and well-maintained is vital. Additionally, encouraging patients to engage in regular physical activity tailored to their needs can enhance their strength, balance, and coordination, further reducing the risk of falls. Working closely with physiotherapists or occupational therapists can help design specific exercises that consider the patient's health condition and treatment plan.
Visual cues, such as coloured socks or armbands, can also be used as part of the prevention plan. These cues help staff quickly identify patients at high risk and initiate the appropriate protocols to prevent falls. Standardizing colours across the hospital, as recommended by the American Hospital Association, can avoid confusion. For example, yellow can indicate a patient at risk of falling.
In addition to patient-specific interventions, hospitals can implement universal interventions to enhance overall safety. These focus on reducing risks in the physical environment and addressing how patients interact with their surroundings and staff. Environmental checklists and hazard report forms can help identify and rectify safety issues, such as obstacles or unsafe design elements.
Finally, it is essential to involve patients and their families in the prevention process. Educating patients about fall risks and providing them with information on how to reduce these risks can empower them to take an active role in their safety. This may include encouraging the use of non-skid footwear, yearly eye exams to update prescriptions, and participating in therapeutic care provided by sitters or companions.
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Improve patient mobility and balance
Improving patient mobility and balance is crucial in reducing the risk of falls in hospitals. Here are some strategies to achieve that:
Firstly, conducting a comprehensive geriatric assessment (CGA) is essential for older patients at risk of falling. The CGA involves a detailed history and physical examination, including assessments of pain, pharmacological history, and laboratory tests to identify underlying causes of falling, such as dehydration, anemia, or diabetes. Additionally, evaluation scales such as the Berg Balance Scale, the Falls Efficacy Scale, and the Timed Up and Go Test can be utilized within the CGA to specifically target balance and mobility issues.
Secondly, encouraging patients to perform exercises that strengthen their legs and improve balance and flexibility is beneficial. This can include physical therapy or occupational therapy, depending on the patient's condition and needs. Even simple movements and gentle exercises can contribute to reducing fall risk, as they promote overall physical well-being and improve strength and balance.
Thirdly, assistive technologies and devices can play a significant role in improving patient mobility and balance. Scooters, reach extenders, walkers, and shower seats are examples of tools that can aid patients in their daily activities, reducing the risk of falls. However, it is important to note that the use of non-slip socks as a fall prevention strategy has been questioned, and a patient's own footwear is often recommended instead to prevent the spread of infections.
Furthermore, medication review is crucial in addressing fall risks. Certain medications, such as antidepressants, sedatives, hypnotics, and benzodiazepines, have been linked to an increased risk of falls in older adults. Therefore, carefully evaluating the risks and benefits of these medications and discontinuing any unnecessary ones can help reduce fall risks associated with medication side effects.
Lastly, it is important to recognize that fall prevention interventions in hospitals may differ from those in community settings due to the unique challenges posed by acute and chronic illnesses, unfamiliar environments, and staffing considerations. Thus, strategies tailored to the hospital setting, such as addressing environmental hazards and providing adequate lighting and contrast, are crucial in improving patient mobility and balance within the hospital context.
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Provide mobility aids
Providing mobility aids is an important strategy to decrease fall risk in hospitals. Mobility aids can help patients who have difficulty walking or maintaining balance, reducing the likelihood of falls. Here are some ways to provide mobility aids effectively:
Assess Patient Needs
Before providing any mobility aid, it is crucial to assess each patient's individual needs and risks. This involves evaluating their mobility, balance, and any underlying medical conditions that may impact their stability. By understanding their specific challenges, appropriate mobility aids can be selected.
Provide Assistive Devices
Offer patients assistive devices such as walkers, canes, or crutches to improve their stability when walking. These devices provide additional support and help prevent loss of balance. Ensure that patients are properly instructed on how to use these devices safely and effectively.
Encourage Early Mobilization
Promote early mobilization protocols to encourage patients to start moving as soon as possible after hospitalization. Early mobilization can help improve patients' strength and balance, reducing their risk of falling. This may include simple exercises, such as walking laps around the ward or using a stationary bike, under the guidance of a physical therapist.
Implement Delirium Prevention Programs
Delirium is a common issue in hospitals and is a leading risk factor for falls. Implement delirium prevention programs, such as the HELP program, which includes volunteer-based walking and mobility activities. These programs can reduce delirium, improve patient cognition, and decrease the likelihood of falls.
Offer One-on-One Assistance
For patients at high risk of falling, provide one-on-one assistance or sitters. These individuals can closely monitor patients and provide direct support to prevent falls. They can also provide therapeutic care and assist with daily activities, ensuring patient safety.
By implementing these strategies and providing appropriate mobility aids, hospitals can significantly decrease the risk of falls and improve patient safety and outcomes. It is important to tailor these interventions to each patient's needs and encourage their active participation in fall prevention efforts.
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Make use of new fall prevention technology
Hospitals can now use innovative technology to predict, prevent, warn of, and detect falls. Stryker, for example, offers smart, connected solutions to support fall prevention protocols and make life easier for healthcare teams. Their smart beds and stretchers, for instance, are designed to keep patients safe and smoothen healthcare providers' daily routines. Stryker's connected solutions, when used with good staff training and solid leadership, have shown impressive results. One hospital witnessed a 64.8% drop in bed-related falls after implementing Stryker's connected beds.
In addition to smart beds and stretchers, video monitoring and pressure sensors, including alarms for beds, chairs, and toilets, can alert nurses and families about impending falls. A more recent innovation, the virtual sitter, adds to video monitoring technology by setting parameters via computer, so that a warning alarm will sound when the patient moves, signalling the potential for a fall.
Innovative fall detection devices have also been created by collaborating clinicians and engineers to utilize advanced technology in preventing falls. One example is a wearable device that does not require the wearer to push a button for activation. This wireless sensor can detect a fall, send the information to a connected smartphone, which uses artificial intelligence (AI) algorithms to determine that a fall has occurred, and communicates directly with the victim. If the person who fell does not reply, emergency contacts and appropriate first responders are notified. Wearable wireless sensors can be integrated into watches, shoes, belts, or clothing.
Other technological advancements that can help reduce and detect falls include a network of ambient sensors, including cameras, pressure detectors, vibration sensors, and infrared sensors. Using motion accelerators, gyroscopes, magnetometers, and Global Positioning System (GPS) technology, sensors detect rapid downward motion and location to recognize a potential fall.
In addition to these innovations, there is also the Fall Tailoring Interventions for Patient Safety (TIPS) Toolkit, which is a nurse-led, evidence-based fall prevention intervention that uses bedside tools to communicate patient-specific risk factors for falls and a tailored prevention plan. The toolkit provides care team members with the information they need to routinely engage in the fall-prevention process.
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Frequently asked questions
Falls are the most frequently reported safety incident in hospitals. Unfamiliar surroundings, medications, and treatments given in the hospital setting, and decreased activity can cause patients to become mentally confused, weak, and unsteady. The most consistently identified risk factors for falls in hospitalized patients include advanced age (>85 years), male sex, a recent fall, gait instability, agitation and/or confusion, new urinary incontinence or frequency, adverse drug reactions, and neurocardiovascular instability.
Hospitals employ various guidelines for fall prevention. These include identifying patients who are at high risk of falling and using clinical judgment to decide on a fall prevention strategy. Hospitals should also take universal precautions to keep all patients safe from falling, such as conducting routine risk assessments and addressing safety issues in the physical environment. Other strategies include using mobility aids, visual cues, and assistive technologies.
One intervention is the Fall Tailoring Interventions for Patient Safety (TIPS) Toolkit, which is a nurse-led, evidence-based fall prevention program. It uses bedside tools to communicate patient-specific risk factors and develop a tailored prevention plan. Another intervention is the TCAB program, which aims to transform leadership, retain and engage nurses, improve quality of care, streamline care, and enhance the patient experience.
