Summary

Although additional patient fall prevention research is needed, current literature offers evidence-based recommendations to prevent inpatient falls. The literature suggests that effective fall prevention programs often employ a team approach that enlists representatives from board members to unlicensed staff. Successful fall prevention teams receive an institutional commitment to implement system-wide change in the form of authority and resources.

Goals are best met when an organization's resources and components are mobilized within an environment of system-wide communication. An effective system adapts to accept changing inputs by adjusting the throughput processes in response to feedback to produce a result that meets its goals.

Here is a summary of recommended approaches to reducing patient falls.

1. Recognize that individual patient fall risk is contingent upon multiple factors.
2. Identify the fall rate per 1,000 patient days for each unit.  Develop a feedback system that regularly and frequently communicates each clinical unit's fall rate to all stakeholders.
3. On admission, implement the universal fall prevention protocol, including:
   • Familiarize the patient with the environment.
     
   • Have the patient demonstrate call light use and keep the call light within reach.
     
   • Keep patient personal possessions within the patient's reach.
     
   • Have sturdy handrails in patient bathrooms, room, and hallway.
     
   • Place the hospital bed in a low position and keep the brakes locked.
     
   • Keep non-slip, well-fitting footwear on the patient.
     
   • Utilize a night light or supplemental lighting.
     
   • Keep floor surfaces clean and dry.
     
   • Educate all caregivers to identify fall risk indicators.
4. Screen every patient for fall risk factors on admission, when there is a change in a patient's condition or treatment, after a fall, and at a change of shift for high-risk patients. The fall risk screening should include fall risk factor identification using standardized unit validated tools like the Morse Fall Scale, Hendrich II Fall Risk Model, or other tools. Tools also need to be specific to the patient population.
5. Communicate the assessed fall risk to patients, family members, and staff by using yellow-colored patient bracelets, signs on doors, bulletin boards in the room, and face to face patient education.
6. Develop a toileting schedule for high-risk patients.
7. Avoid single occupancy rooms for confused and disoriented patients.
8. Provide adequate staffing to assist and monitor patients.
9. Minimize the use of restraints and side rails.
10. Regularly evaluate the fall prevention program results and make modifications as necessary based on feedback.

Inpatient fall prevention is a continuous improvement process.  Your organization's fall prevention program should monitor current research and adopt relevant findings to continuously reduce patient fall risk.