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How to Reduce Patient Falls in Hospitals
Patient falls remain a serious problem in hospitals and cost the industry a great deal of money. Between 700,000 and 1 million patients fall in hospital each year with 30-50 percent resulting in injuries that lead to longer stays and costs.

Patient falls can also cause psychological distress and harm to staff. In addition, they increase patient and family dissatisfaction.
Risk Factors

A patient's risk for falling varies according to intrinsic and extrinsic factors. Intrinsic risk factors include age, a history of falls, the presence of co-morbidities, and certain medications such as antianxiety and antipsychotic drugs. Extrinsic factors include the physical environment and other factors such as clutter or a slippery floor.

In hospital and other acute-care settings, a fall-risk assessment should be performed on each patient upon admission, transfer to a new unit, or after a change in the patient's condition. Several standard assessments are available.

A patient's fear of falling is an important risk factor. This can cause the person to limit or avoid physical activity and may contribute to a loss of muscle strength and balance. Other risk factors include dehydration, poor nutrition, and an unstable or abnormal gait pattern. The use of sedatives can also increase the risk of falling. Countless people die and suffer life-changing injuries every year from falls in hospital settings.
Causes

Fall-related injuries are a major cause of hospital admissions, and in older adults, a fall is the number one reason for a nursing home stay. Falls can cause fractures and other serious health problems, such as loss of independence, disability and death.


A patient’s underlying medical condition and medications may increase their risk of falling. For example, patients with uncontrolled diabetes, heart disease and problems with their nerves, feet or blood vessels may be at higher risk. Medications that can cause drowsiness, confusion and orthostatic (dropping) blood pressure also put patients at risk for falling.

Some patients become agitated or confused, and they may refuse to use the call button for help getting out of bed or walking down the hall. They can overestimate their abilities and be more confident than they actually are, leading them to attempt walking without assistance. In such cases, a careful clinical review and a root cause analysis should be conducted.
Prevention

Many falls in hospital are physiological, unavoidable and cannot be prevented (see tool 3A). However, there are a number of steps hospitals can take to reduce patient fall rates.

The basic strategies are standardization of fall prevention practices and patient-specific care planning. A hospital’s care planning should include a risk assessment and specific interventions to address identified risk factors. This should be done for all patients on every shift, using tools such as hourly rounds and patient handoffs.

Hospital staff should also communicate with each other about falls, including identifying which patients have fallen and how they fell. This information can help other staff prevent similar falls.

Mercy Health-Anderson Hospital reduced the rate of falls in its med/surg unit from 10 per 1,000 bed days to 2 per 1,000 by following a comprehensive approach that focused on reducing patient falls and injuries. They posted signs in patient rooms asking patients to call for assistance when getting out of bed, used bed alarms, hung whiteboards showing unit fall rates and held twice-daily huddles to discuss which patients were at risk of falling.
Treatment

Identifying and mitigating risk factors for patient falls is a key quality improvement theme, but the application of multifactorial assessments linked to appropriate interventions is often suboptimal at ward level. For example, many medical/surgical units fail to routinely assess a patient’s mobility needs, toileting and continence, medication review (including potential side effects such as dizziness or orthostatic hypotension), vision, confusion (dementia or delirium) and environmental risk factors such as clear signage, minimising clutter and provision of mobility aids.

Studies on hospital-based patient education have demonstrated that patients who are informed about falls are more likely to use the call bell if they fall or are at risk of falling, which may prevent some falls. st john personal alarm However, more research is needed on the design and delivery of effective educational programmes for patients with impaired cognition. A scoping review found that most of the education programmes identified did not employ evidence-based teaching principles or learning theories. These may help improve patient engagement.

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