Hailey Tran
Falls in hospitals are a frequent and debilitating problem worldwide. While not all falls are preventable, 20-30% can be prevented by assessing risks and intervening to reduce them. Strategies to prevent falls in hospitals have included clinician education, environmental modifications, assistive devices, hospital systems, and medication reviews. However, the role of patients in preventing falls while in hospital has been understudied. There is emerging evidence that patient education can reduce falls and associated injuries. Other interventions such as alarms, ''high-risk' wristbands, and bed signage have not been successful in reducing fall rates.
| Characteristics | Values |
|---|---|
| Risk factors | Advanced age (over 85 years), male sex, a recent fall, gait instability, agitation and/or confusion, new urinary incontinence or frequency, adverse drug reactions, neurocardiovascular instability |
| Preventative measures | Face-to-face patient education, educational tools, patient-focused consumer materials, hospital systems, policies and procedures, medication reviews, assistive devices, environmental modifications, clinician education |
| Strategies | Quality improvement studies, cluster randomized controlled trials, alarms, universal precautions, hourly rounding protocols, environmental checklists, hazard report forms |
| Recommendations | Get eyes checked annually, wear appropriate footwear, exercise safely, use assistive technologies, get assessed for risk factors |
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What You'll Learn
The importance of patient education
Falls in hospitals are a frequent and debilitating problem worldwide, and the risk of serious injury or even death increases with age. While falls are not always preventable, a coordinated multidisciplinary clinical team approach can reduce their incidence. Patient education plays a vital role in fall prevention, and hospitals should implement universal interventions to safeguard all patients, regardless of their fall risk status.
Patient education about fall risks and preventative measures is essential. Face-to-face education, educational tools, and patient-focused materials like pamphlets can effectively convey this information. Hospitals should also provide patients with information about hospital systems, policies, and procedures related to fall prevention. By empowering patients with knowledge, hospitals can reduce the incidence of falls and associated injuries, such as bruising, lacerations, or fractures.
Patient education should also extend to the families of cognitively impaired hospitalised patients. This ensures that patients receive support and reinforcement of fall prevention strategies even after they leave the hospital. Additionally, patients should be encouraged to report environmental hazards that the hospital's maintenance staff can address.
Healthcare providers should also assess patients' risk factors for falls, including advanced age, male sex, recent falls, gait instability, agitation, confusion, urinary issues, adverse drug reactions, and neurocardiovascular instability. Identifying these risk factors and implementing clear interventions can significantly reduce the incidence of inpatient falls.
Finally, patients should be encouraged to take ownership of their fall prevention. This includes getting regular eye exams to ensure their glasses prescription is up to date and choosing non-skid footwear. Patients can also benefit from physical therapy or occupational therapy to improve their balance and stability. These measures empower patients to take an active role in fall prevention and improve their overall safety.
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Environmental modifications
Firstly, hospitals should encourage a culture of vigilant safety consciousness among staff. This includes continuous feedback, learning from adverse events, and conducting risk assessments to identify and mitigate potential hazards. It is essential that all staff members, regardless of their role or discipline, actively work to prevent falls and reduce harm.
Secondly, hospitals can utilize the Agency for Healthcare Research and Quality Fall Prevention Toolkit. This toolkit offers various tools and protocols, such as the Environmental Checklist, to identify and address safety issues in the physical environment. The Environmental Checklist helps identify potential hazards, such as obstacles on the floor, that may contribute to falls. By regularly inspecting and maintaining the environment, hospitals can significantly reduce fall risks.
Additionally, hospitals can implement universal fall precautions, which are common-sense steps to enhance patient safety. These precautions may include ensuring proper lighting, using non-slip mats in bathrooms, and providing appropriate footwear for patients. Hospitals can also introduce assistive devices, such as scooters, reach extenders, and walkers, to help patients with their daily activities and improve their mobility, thereby reducing the risk of falls.
Furthermore, hospitals should consider implementing multifactorial assessments linked to appropriate interventions. While the optimal combination of components is not yet clear, addressing multiple risk factors simultaneously has been shown to reduce falls in hospitals by 20-30%. This comprehensive approach considers the complex interplay of factors contributing to falls and aims to provide tailored interventions for high-risk patients.
By combining these environmental modifications with a culture of safety consciousness, hospitals can effectively reduce the risk of falls and create a safer environment for patients, visitors, and staff.
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Assistive devices
There are various types of assistive devices available, and they are not just for patients with chronic illnesses or disabilities. For example, scooters, reach extenders, walkers, and sock assists can aid in mobility and reduce the risk of falling. Additionally, shower seats can provide stability and safety when bathing. These devices can be particularly useful for older adults or individuals with balance issues.
Another type of assistive device is non-skid footwear, such as slipper socks with non-skid treads. These can provide traction and prevent slipping, especially on smooth or wet surfaces. This is especially important in hospitals, where floors may be slippery due to cleaning or spills.
In addition to mobility and stability, assistive devices can also include tools for inspecting and maintaining a safe physical environment. The Agency for Healthcare Research and Quality Fall Prevention Toolkit offers various tools, such as the Hourly Rounding Protocol, Environmental Checklist, and Hazard Report Form. These tools help identify and address safety hazards, ensuring that the environment is as fall-proof as possible.
While assistive devices are crucial, it is important to note that they should not be solely relied upon for fall prevention. Patient education, environmental modifications, hospital systems, and medication reviews are also essential components of a comprehensive fall prevention strategy in hospitals.
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Hospital systems
Hospital falls are a frequent and debilitating problem worldwide. Hospital systems play a crucial role in fall prevention strategies, alongside clinician education, environmental modifications, assistive devices, and medication reviews.
One key hospital system is the implementation of a multidisciplinary clinical team approach. This involves identifying multiple underlying risk factors and developing clear interventions to reduce their impact. Strong leadership and organisational oversight are important in combining this cultural evolution with relevant evidence and rigorous measurement of performance, ultimately improving patient safety.
Another hospital system is the utilisation of universal interventions, which focus on reducing risks in the physical environment and addressing how patients interact with the environment and staff. These include the Agency for Healthcare Research and Quality Fall Prevention Toolkit, which offers tools such as the Scheduled Rounding Protocol to ensure patient needs are met, the Environmental Checklist to identify and resolve safety issues, and the Hazard Report Form to address environmental hazards.
Additionally, hospital systems can include policies and procedures to assist patients in preventing falls. While studies on fall prevention often take the form of quality improvement (QI) studies, they may not be considered conclusive evidence due to their less rigorous nature and potential lack of clarity. Cluster randomised controlled trials (cRCTs) are a stronger study design, allowing for randomisation and outcome assessment at the patient level or a larger unit level.
Furthermore, hospital systems can involve the use of technology, such as electronic surveillance video systems, in-room webcams, and digital conversational agents to support nurse teams and mitigate risks. While alarm systems have been commonly used, evidence suggests they are ineffective in fall prevention and may even contribute to confusion and agitation, especially in cognitively impaired patients.
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Medication reviews
A medication review is defined as "a structured evaluation of a patient's medicines with the aim of optimizing medicines use and improving health outcomes". Reviews can be conducted by physicians, geriatricians, pharmacists, nurses, or physiotherapists, who then make decisions on whether to change the medication regimen.
There have been several studies investigating the effectiveness of medication reviews in preventing falls. Four studies used medication review as a single intervention, while ten assessed its effect as part of multifactorial interventions. The results of these studies are conflicting. While some suggest that medication reviews can improve the prevention of fall-related injuries, others found no positive impact on reducing hospital admissions or ADRs.
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Frequently asked questions
Some ways to prevent falls in hospital nursing include wearing appropriate footwear, using mobility aids, and getting yearly eye exams. Hospitals can also implement universal interventions, such as checklists and hazard report forms, to reduce fall risks for patients, visitors, and staff.
Advanced age (over 85 years), male sex, a recent fall, gait instability, agitation and/or confusion, new urinary incontinence, adverse drug reactions, and neurocardiovascular instability are some of the most consistently identified risk factors for falls in hospitalised patients.
Hospitals can employ a coordinated multidisciplinary clinical team approach to reduce fall incidents. This involves identifying multiple underlying risk factors and implementing clear interventions to reduce their impact. Strong leadership and organisational oversight are crucial to combine cultural evolution with rigorous performance measurement and improve patient safety.
