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 institutional commitment in the form of: authority and resources to implement system-wide change.

A systems approach to change recognizes that goals are best met when the resources and components of an organization 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, inorder to produce an output that meets organizations goals.

Input

1. Recognize that individual patient fall risk is contingent upon multiple factors.

Throughput

2. Identify the fall rate per 1,000 patient days for each unit.  Develop a feedback system that regularly and frequently communicates the fall rate of each clinical unit 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 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 patient condition or treatment, after a fall and at change of shift for high risk patients. The fall risk screening should include fall risk factor identification using a standardized unit validated tool like the Morse Fall Scale, Hendrich II Fall Risk Model or the Stratify Scale.

5. Communicate the assessed fall risk to patients, family members as well as 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 schedules 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. 

Output and feedback

10. Regularly evaluate the results of the fall prevention program and makemodifications 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.

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