Logan Reid
Falls in hospitals are the most frequently reported safety incident, with more than 250,000 recorded annually in England and Wales, and 700,000 to 1 million in the United States. They can result in significant physical and psychological harm to the patient, increased hospital stays, and increased costs. While not all falls are preventable, 20-30% can be prevented by assessing risks and intervening to reduce these risks. This requires a coordinated, multidisciplinary clinical team approach, with the active engagement of multiple disciplines and teams that care for the patient. This PowerPoint presentation will outline the challenges associated with developing, implementing, and sustaining a fall prevention program, and provide tools and strategies to address these challenges.
| Characteristics | Values |
|---|---|
| Definition of a fall | An unplanned descent to the floor with or without injury to the patient |
| Who is at risk of falling? | Advanced age (>85 years), male sex, recent fall, gait instability, agitation and/or confusion, new urinary incontinence or frequency, adverse drug reactions (especially psychotropic drugs), neurocardiovascular instability (e.g. orthostatic hypotension) |
| Risk assessment tools | Fall risk screening tools, fall risk scores, the Fall Tailoring Interventions for Patient Safety (TIPS) toolkit |
| Prevention strategies | Use of sensors, bed alarms, non-slip socks or appropriate footwear, medication review, discontinuing medications that increase fall risk, environmental modifications, staff education, patient education, remote patient monitoring |
| Post-fall protocols | First aid, ensure patient safety, ask for help, complete post-fall reassessment, report fall, patient and family education |
| Challenges | Developing, implementing, and sustaining a fall prevention program, limited evidence to guide effective fall prevention, contamination of intervention onto control patients, insensitive risk screening tools, lack of standardisation in prevention practices |
| Benefits of fall prevention | Reduced physical and psychological harm to patients, reduced hospital stays, reduced monetary costs, improved patient safety and quality of life |
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What You'll Learn
- Risk factors: advanced age, male sex, recent fall, agitation, confusion, incontinence
- Individualised strategies: sensors, bed alarms, non-slip socks, medication review, room modifications
- Multidisciplinary collaboration: staff training, leadership, continuous measurement, standardisation of care
- Patient education: orientation, fall-prevention techniques, use of call bell, side rails, bedpan/urinal
- Post-fall protocols: first aid, patient safety, reassessment, reporting, patient/family education
Risk factors: advanced age, male sex, recent fall, agitation, confusion, incontinence
Risk Factors and Prevention Strategies for Falls in Hospitals
Advanced Age
Falls are a significant cause of concern in older adults, often resulting in injuries, disability, and even death. Research has shown that individuals aged 65 and above are particularly vulnerable to falls, with a higher risk among women. As age-related physical and cognitive decline can increase the likelihood of falling, hospitals should implement tailored interventions for older patients, such as providing non-slip socks, ensuring optimal lighting, and offering assistance with mobility.
Male Sex
While women generally have a higher risk of falls, certain studies suggest that sex-specific risk factors may be at play. For instance, predisposing factors for delirium, which can lead to agitation and falls, include male gender. Additionally, men and women may have different baseline characteristics and incident fall associations, highlighting the need for further investigation into sex-specific prevention strategies.
Recent Fall
A history of falls is a critical risk factor. Patients who have experienced a recent fall are more likely to fall again, often due to fear and reduced physical activity. Hospitals can address this by identifying high-risk patients and implementing targeted prevention strategies, such as providing appropriate mobility aids and ensuring a clear and safe environment.
Agitation and Confusion
Agitation, often associated with delirium, dementia, or substance use, can increase the risk of falls. It is essential to identify the underlying causes of agitation and provide prompt treatment. Hospitals should aim to reduce patient stress, improve sleep quality, and address individual needs to mitigate agitation and prevent falls.
Incontinence
Urinary incontinence is a significant risk factor for accidental falls. Episodes of incontinence can lead to slipping on wet floors, especially when rushing to the toilet in unfamiliar or poorly lit areas. Hospitals should encourage the use of absorbent products, ensure easy access to toilets, and provide non-slip mats to reduce the risk of falls associated with incontinence.
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Individualised strategies: sensors, bed alarms, non-slip socks, medication review, room modifications
Individualised strategies are an important aspect of fall prevention in hospitals. Here are some strategies that can be employed:
Sensors
Wearable sensors, such as alert bracelets, can be used to monitor patients and prevent falls. These sensors can be linked to radio pagers or other alert systems to notify staff if a patient is at risk of falling. While some studies have shown the effectiveness of these sensors in preventing falls, others have found no significant impact.
Bed Alarms
Bed alarms are another commonly used tool to prevent falls in hospitals. These alarms can be placed on the bed or bedside chair and notify staff when a patient attempts to get up. However, studies have shown mixed results regarding their effectiveness, with some indicating no significant reduction in fall rates.
Non-Slip Socks
Providing patients with non-slip or traction socks can improve their grip and stability when walking, reducing the risk of falls. This is especially important on slippery floors or for patients who may have balance issues.
Medication Review
A medical review of patient medications can help identify drugs that may increase the risk of falling. Certain medications can cause dizziness, balance issues, or other side effects that make patients more prone to falling. Adjusting medication regimens can potentially reduce fall rates.
Room Modifications
Modifying patient rooms can also help prevent falls. This includes ensuring beds are locked and lowered, providing bedside commodes, improving lighting and flooring to reduce trip hazards, and ensuring call lights are accessible. Additionally, web cameras in patient rooms have shown a significant reduction in falls, allowing for better monitoring and quicker response times.
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Multidisciplinary collaboration: staff training, leadership, continuous measurement, standardisation of care
Preventing falls in hospitals is a complex task that requires a multidisciplinary approach involving collaboration between various hospital departments and staff members. It is essential to have strong leadership and organisational oversight to combine cultural evolution with relevant evidence and rigorous measurement of performance to improve patient safety.
Staff training is a crucial aspect of fall prevention. Nurses and other healthcare professionals should be educated about fall risk factors and evidence-based prevention strategies. They should also be trained to use specific tools and protocols, such as raising side rails, ensuring call bells are within reach, and providing education to patients and their families about fall prevention. Standardised care practices should be implemented, including accurate and consistent risk assessments that consider individual factors like comorbidities, confusion, muscle weakness, and environmental factors.
Leadership plays a vital role in fall prevention. Hospital leaders should be engaged and educated about fall prevention initiatives, such as the "Preventing Falls in Hospitals Toolkit," to facilitate change. Leaders should work with implementation teams to address specific challenges, develop action plans, and adapt tools and resources to the hospital's needs. Strong leadership is necessary to nurture a culture of vigilant safety consciousness, where all staff members are encouraged to actively participate in fall prevention efforts.
Continuous measurement and data collection are essential components of fall prevention. Hospitals should regularly assess fall rates, analyse root causes, and track the effectiveness of implemented strategies. This data should be reported to hospital leadership and used to inform decision-making and guide improvements. Continuous measurement ensures that hospitals can adapt their approaches based on the most up-to-date information and identify areas that require additional attention or resources.
Standardisation of care is critical to effective fall prevention. Hospitals should strive for consistency in their practices and protocols by implementing evidence-based guidelines and protocols. Standardisation ensures that all patients receive the same level of care and that fall prevention strategies are applied consistently across the hospital. This includes standardising risk assessments, interventions, and post-fall protocols to improve patient safety and reduce the incidence of falls.
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Patient education: orientation, fall-prevention techniques, use of call bell, side rails, bedpan/urinal
Patient education is an essential component of fall prevention in hospitals. Here are some ways to educate patients on orientation, fall prevention techniques, and the use of call bells, side rails, and bedpans/urinals:
Orientation
Patients should be oriented to their surroundings, including the location of essential amenities and items within their room, such as the call bell, television remote, eyeglasses, and toilet. This orientation can help patients feel more comfortable in their environment and reduce the risk of falls due to unfamiliarity.
Fall Prevention Techniques
Educate patients on their fall risk factors and encourage them to participate in preventive behaviour changes. This includes raising awareness about the importance of regular urination and bowel movements to prevent falls caused by rushing to the bathroom. Additionally, patients should be encouraged to report any environmental safety issues that may contribute to fall risks, such as obstacles within their path.
Use of Call Bell
Patients should be instructed on how and when to use the call bell to request assistance. This is particularly important for patients who may need help with toileting or other activities that could increase their risk of falling if performed without support.
Use of Side Rails
Patients should be educated on the purpose and proper use of side rails. Side rails can provide support and stability when getting in and out of bed, reducing the risk of falls. Patients should be instructed to keep the side rails up when sleeping or lying down and to lower them only when necessary, such as when getting out of bed.
Use of Bedpan/Urinal
Patients who are unable to walk to the bathroom due to illness, injury, or surgery may require the use of a bedpan or urinal. Educate patients on the availability and proper use of these devices, including the different types available (e.g., metal or hard plastic) and the importance of maintaining privacy and cleanliness during and after their use.
By providing comprehensive patient education that covers orientation, fall prevention techniques, and the use of call bells, side rails, and bedpans/urinals, hospitals can empower patients to take an active role in fall prevention and improve their overall safety during their hospital stay.
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Post-fall protocols: first aid, patient safety, reassessment, reporting, patient/family education
When a patient experiences a fall, staff are required to undertake rapid assessment and basic life support (if required) and complete observations. They must follow local Clinical Emergency Response Systems (CERS) and, if a staff member or family member is concerned about the patient, they should call for a Clinical Review.
First Aid
First aid procedures following a fall should include a review of the patient's systems and a description of any injuries. The patient should be stabilised and provided with immediate treatment if necessary.
Patient Safety
To ensure patient safety, residents should be monitored for at least 72 hours after a fall. Each shift, nurses should record a review of systems, noting any changes in symptoms and the treatment provided. This information should be clearly documented in the nurse's notes.
Reassessment
The patient's condition before, during, and after the fall should be evaluated to identify possible causes and risk factors. This may include abnormal vital signs, postural blood pressure, apical heart rate, and finger-stick glucose for diabetics. Laboratory tests such as CBC, urinalysis, pulse oximetry, electrolytes, and EKG may also be necessary.
Reporting
The Tracking Record for Improving Patient Safety (TRIPS) is used to report all types of falls. A written description of the fall circumstances, including environmental factors, equipment, and staff activity, is critical for understanding the incident and implementing preventive measures.
Patient/Family Education
The patient and their family should be involved in the fall prevention process. This includes providing education on fall risks and prevention strategies, as well as seeking their input on changes in care and alternative interventions.
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