Ethan Rhodes
Falls in hospitals are the most frequently reported safety incident, with more than 250,000 recorded annually in England and Wales. While not all falls are preventable, 20-30% can be prevented by assessing risks and intervening to reduce them. A coordinated multidisciplinary clinical team approach can reduce the incidence of inpatient falls. Hospitals employ various guidelines for fall prevention, including identifying patients at high risk of falling and using clinical judgment to decide on a fall prevention strategy. The CDC's STEADI initiative provides best practices for developing an inpatient program to prevent falls among older adults. Additionally, toolkits such as Fall TIPS have been developed to help patients, families, and healthcare providers engage in the fall prevention process. Environmental factors, such as clutter, cords, and furniture placement, should also be considered in fall prevention strategies.
| Characteristics | Values |
|---|---|
| Hospitals' fall prevention strategies | Identify patients who are at high risk of falling |
| Use clinical judgment to decide on fall prevention strategies to utilize to reduce fall risk | |
| CDC's STEADI inpatient best practices | Help inpatient teams integrate a fall prevention program into their existing workflow and clinical practice |
| Decrease patient falls during and after hospital stays | |
| Promote better collaboration with external providers for post-discharge care | |
| STEADI's inpatient program | Includes 10 practical steps informed by research findings and provider experiences |
| STEADI's target group | Older adults who are at risk of falling, or who may have fallen in the past |
| STEADI's impact | Statistically significant decrease in the length of stay in the hospital |
| STEADI's impact | Increase in the percentage of patients discharged home |
| STEADI's impact | Improvement in the quality of life for many patients |
| Ways to help prevent falls in the hospital | Remind children to move slowly when getting up from a bed or chair |
| Use assistive devices, wear socks with grips, and help children with movement tasks | |
| Use foot braces, crutches, wheelchairs, walkers, or canes if recommended | |
| Wear non-slip, supportive shoes that fit well | |
| Avoid loose clothing that may cause tripping |
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What You'll Learn
Identify patients at high risk of falling
Hospitals employ various methods and guidelines to identify patients at high risk of falling. These guidelines help determine which fall prevention strategies to use to reduce the risk.
The CDC STEADI initiative provides best practices and resources to help healthcare providers identify and treat older adults who are at risk of falling or may have fallen in the past. The STEADI guide includes 10 practical steps to decrease patient falls during and after hospital stays.
There are several predictive tools that use known risk factors to calculate a patient's risk of falling. These tools consider patient characteristics, circumstances, and activities that may contribute to falls. Some of these risk factors include weakness, poor cognitive status, impaired balance or gait, altered mobility, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, and use of certain medications. Additionally, the physical environment can also contribute to falls, such as flooring type and bed height.
Fall risk assessments are commonly used to determine if an individual has a low, moderate, or high risk of falling. These assessments include a series of tasks and tests that evaluate strength, balance, and gait. For example, the Timed Up-and-Go test measures the time it takes to stand up from a chair, walk a short distance, and sit down again. If an individual takes 12 seconds or more to complete this task, they may be at a higher risk of falling. The 30-Second Chair Stand Test evaluates strength and balance by counting how many times an individual can stand up and sit down from a chair in 30 seconds. The 4-Stage Balance Test assesses balance by challenging the individual to maintain different standing positions for 10 seconds each, with the difficulty increasing at each stage.
While these assessments and tools provide valuable insights, it's important to recognize that fall prediction is complex and subject to change. A patient's risk for falling can vary over time, requiring periodic reassessments.
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Implement STEADI inpatient best practices
Falls can have significant physical and economic impacts on patients and medical organisations. The Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for fall-related injuries back in 2008, so hospitals are keen to find a solution to prevent falls.
The CDC's STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative was created for healthcare providers treating older adults who are at risk of falling. The program is designed to help inpatient teams integrate a fall prevention program into their existing workflow and clinical practice. The STEADI inpatient best practices guide includes 10 practical steps informed by research findings and provider experiences to decrease patient falls during and after hospital stays.
The guide suggests inpatient teams should:
- Identify patients who are at high risk of falling.
- Use clinical judgment to decide which fall prevention strategies to use to reduce fall risk.
- Implement fall prevention strategies such as removing climbable furniture from rooms, supervising patients, and educating patients and their families about fall prevention.
- Collaborate with external providers for post-discharge care to reduce the risk of falls after hospital stays.
- Utilise pharmacists to mitigate the risk of falls by reviewing medications that may cause side effects such as dizziness, drowsiness, or coordination issues.
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Assess visual alertness and improve vision
Falls are the second leading cause of accidental deaths worldwide, especially among older people. Poor vision is a significant risk factor for falls, with older people experiencing reduced visual function, impaired colour perception, altered depth perception, and delayed response and reaction times. Therefore, it is essential to assess visual alertness and improve the vision of patients, especially older adults, to prevent falls in hospitals.
Assessing Visual Alertness and Improving Vision:
- Vision Assessment: Hospitals should incorporate a vision assessment into the multifactorial risk assessment for older adults. This includes checking for any visual problems, such as reduced visual acuity, impaired colour perception, and altered depth perception. The Royal College of Physicians and the British and Irish Orthoptic Society have developed a bedside vision check tool that uses questions and visual aids to help medical professionals assess a patient's eyesight.
- Encourage Regular Eye Examinations: Nurses and doctors should inform patients, especially those with known vision problems, about the importance of regular eye examinations and the use of appropriate visual aids, such as eyeglasses. This can help identify vision issues early on and ensure patients use the correct aids to improve their visual orientation and reduce hazards.
- Environmental Modifications: Hospitals should ensure adequate lighting and remove environmental hazards that can contribute to falls, such as clutter, uneven surfaces, and insufficient lighting. Improving lighting conditions can enhance patients' visual alertness and reduce the risk of tripping or falling due to poor visibility.
- Exercise and Intervention Programs: Hospitals can implement exercise and intervention programs specifically designed to improve patients' balance, gait, and muscle strength. These programs can help older adults improve their stability and reduce the risk of falling, especially those with muscle weakness or delayed response times.
- Medication Review: Hospitals should review patients' medications to identify any drugs that may contribute to falls. Certain medications, such as tranquilizers, narcotics, and sedatives, can affect balance, coordination, and alertness, increasing the risk of falling. Adjusting medications or dosages may be necessary to reduce these side effects and improve patients' visual alertness and overall stability.
- Staff Education and Responsiveness: Hospital staff, including nurses and caregivers, should be educated about the risk factors for falls, including visual impairment. They should be responsive to patients' needs and call lights, as prompt assistance can help prevent falls. Staff should also be trained to identify patients at high risk of falling and employ appropriate fall prevention strategies, such as assisting patients with mobility and ensuring a safe environment.
By implementing these measures, hospitals can effectively assess visual alertness and improve patients' vision, significantly reducing the risk of falls and promoting patient safety.
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Use assistive devices, wear non-slip shoes
Patients can use assistive devices such as foot braces, crutches, wheelchairs, walkers, or canes to aid their movement. These devices can help patients who have difficulty walking or get tired quickly to move around more safely.
In addition, wearing non-slip, supportive shoes that fit well can reduce the risk of falling. Shoes with good grip can provide stability and balance, especially on slippery or uneven surfaces. It is important to avoid wearing shoes that are too big or have smooth soles, such as flip-flops, as they can increase the risk of slipping or tripping.
For patients who prefer to walk barefoot, wearing socks with grips on the bottom can provide a similar benefit to non-slip shoes. This combination of grip and balance can help prevent falls, especially on smooth or slippery floors.
By utilising assistive devices and wearing appropriate footwear, patients can significantly reduce their risk of falling and improve their overall stability and safety during their hospital stay. These measures are simple yet effective ways to enhance patient safety and prevent fall-related injuries, which can have serious physical and economic consequences.
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Evaluate gait, strength, and balance
Gait, strength, and balance are key factors in preventing falls in hospitals. Healthcare providers should be vigilant in anticipating, observing, questioning, and testing patients to prevent and remedy problems that can lead to falls.
An informal assessment of a patient's gait can begin with simple observation. Does the patient require assistance walking down the hall or getting up from a chair? Is their gait continuous and fluid, or is it halting and unsteady? Are they wearing ill-fitting shoes, slick soles, or high heels that can increase their risk of falling?
The Timed Up-and-Go (TUG) test is a more formal evaluation of a patient's gait and movement. The patient starts in a chair, stands up, walks a short distance at their regular pace, and then sits down again. The time it takes to complete this task is recorded, with a duration of 12 seconds or more indicating a higher fall risk.
The Tinetti Balance and Gait test is a standardized evaluation of mobility and stability. It assesses balance and gait individually, with 16 items in total. During the balance assessment, the patient is judged while sitting, arising, standing (both immediate and prolonged), and turning. Their ability to maintain balance is also tested by attempting to disrupt their balance and testing without a horizon reference (eyes closed). These indicate body control and strength. In the gait assessment, the right and left feet are evaluated separately for swing (step length) and clearance, and then compared.
The 30-Second Chair Stand Test is another way to evaluate strength and balance. The patient sits in a chair with their arms crossed over their chest and stands up and sits down as many times as possible in 30 seconds.
By evaluating gait, strength, and balance, healthcare providers can identify areas of concern and implement appropriate interventions to reduce the risk of falls in hospitals.
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Frequently asked questions
Falls in hospitals can be caused by a variety of factors, including medical conditions, cognitive impairments, medications, unanticipated medical events, and unfamiliarity with the physical space. Patients who are over the age of 85, male, have a history of recent falls, or exhibit confusion are also at a higher risk of falling.
Hospitals can implement various guidelines and strategies to reduce the risk of falls. This includes regularly assessing the environment for potential hazards, such as clutter, cords, and poorly designed furniture. They can also identify patients who are at high risk of falling and develop personalized prevention plans for them.
Healthcare providers can utilize tools such as the STEADI initiative and the Fall TIPS toolkit, which provide practical steps and evidence-based interventions to prevent falls among older adults. They can also encourage a culture of vigilant safety consciousness through continuous feedback and learning from adverse events.
Patients and families can work closely with healthcare providers to understand and mitigate fall risks. They can also educate themselves about reporting procedures and stay actively engaged in the fall prevention process. In addition, patients can seek help if they experience near misses or medication side effects that may contribute to falls, such as dizziness or drowsiness.
