Preventing Patient Falls

Article by:  Deborah Nadzam, Practice Leader, Patient Safety, Joint Commission Resources

National Patient Safety Goal 09.02.01 requires the organization to implement and evaluate a falls reduction program. At the patient level, an effective fall prevention program begins with a robust process for assessing the patient’s risk of falling and the patient’s risk of injury.  At a minimum, assessment needs to occur on admission, following a change in the patient’s condition, after a fall, and when the patient is transferred.  If it is determined that the patient is at risk for falling, then regular assessment must continue.  Physiological factors contribute to the patient’s of risk of injury (e.g., frail, osteoporosis, medication regimens such as antiplatelet therapy, low Body Mass Index). Identification of these factors requires careful history-taking, physical examination and laboratory assessment.

Once the patient is determined to be at risk of falling or injury, it becomes a priority to communicate this risk to all staff, the patient, and the patient’s family, accomplished through the medical record, handoff communications, signage (door, wall, wristband), and other modalities that continue to alert staff to the patient’s risk. Patient-level interventions to prevent falls and injuries include medication adjustment, environmental adjustment, alarm devices, calcium and vitamin D, exercise interventions, toileting regimens, and treatment of other underlying disorders. Several studies have found that multi-pronged prevention strategies are more effective than any single intervention. Interventions to prevent injury in the acute and long-term care settings include limiting restraint use, lowering bedrails, using hip protectors in long-term care, calcium with vitamin D, and possibly bisphosphonates in long-term care.

Obvious organizational level activities include creating safe environments (in general and specific to patients) and educating all staff about falls and injury prevention. A secondary, but critical, organizational activity related to falls prevention is measurement and improvement.  Honest, transparent reporting of falls must be encouraged to analyze conditions associated with falls, identify patterns of risk, and develop improved care processes.