Notes

Preventing Patient Falls in the ED
Patient falls are a common problem in hospitals. They're costly and can be dangerous for the patients. They also degrade the valuation of hospital care.

To understand what causes a patient to fall, it is important to record both total and injury falls. This will help you assess your unit's preventative measures and identify areas for improvement.
Risk Factors

There are multiple risk factors that contribute to patient falls. Some, such as age, can be modified and others cannot. These include muscle weakness, loss of balance and vision, solitary living, impaired lower limb strength, depression, vertigo, diabetes, arthritis and chronic conditions.

Most of the time, accidental falls stem from slipping or tripping and are linked to extrinsic factors in the physical environment. Many hospitals are reevaluating the design of rooms and bathrooms to decrease environmental fall risks.

Physiological falls account for the majority of in-hospital falls and are those that could be prevented. These include falling from a bed or chair, incontinence, a change in gait, the use of sedatives and antipsychotics, or polypharmacy (defined as taking more than four medications) (Groutas & Staggs 2014:40). These are falls that could be identified prior to the fall and interventions can be put in place to prevent them. Medical Alert These may include a risk assessment tool but it is important that the results of this are then communicated to the rest of the team and a care plan devised for the patient.
Common Causes

A number of factors can cause patient falls. These include medications, which can increase dizziness and confusion. Other causes can include lack of exercise (which weakens muscles), arthritis and chronic diseases such as Parkinson’s disease and Alzheimer’s. In addition, environmental hazards like poor lighting, slippery or uneven flooring, and clutter can increase the risk of falling.


Research suggests that identifying patients as high-risk for falls and taking assertive preventative measures can reduce fall rates. However, the fact remains that patient falls occur in hospitals and can result in serious injury. This can have a negative impact on a patient’s quality of life and family caregivers. The experienced professionals at Warshauer Woodward Atkins have helped many families with loved ones who have fallen in hospital and incurred injuries as a result. Contact us today to find out how we can help you.
Preventative Measures

Patient falls can be prevented by making sure the environment is safe for ambulation and transfers. This includes providing sturdy surfaces for patients to transfer on and reducing trip hazards. Providing the right amount of exercise improves balance, flexibility and muscle strength; with a physician's OK, consider walking or water workouts for patients who are able.


Education about falls risks and prevention can help reduce patient and family knowledge gaps. However, the effectiveness of this strategy varies by hospital settings and patient characteristics. Some studies that have evaluated falls prevention education interventions (see Tool 3L) suggest that incorporating theories of health behaviour change and educational design principles may be important for increasing the success of these programs.

Incorporating a risk factor assessment and care plan in the daily patient flowsheets ensures that all staff members are aware of a patient's fall risk factors. This can be done by including a section in the template discussed in 3.4 and incorporating discussion of a patient's risk factors into shift reports or patient handover.
Post-Fall Care

The immediate post-fall period is a high risk time for repeat falls in older adults. Many ED evaluations do not include a patient-centered assessment of modifiable fall risks [1].

On admission or hospitalization, each patient should be screened with a standardized tool and elicited for a history of falls. Nurses should also perform a thorough physical examination and note any abnormalities.

personal emergency response After a patient falls, nurses should initiate a post-fall huddle to discuss the cause of the fall and plan for prevention. This huddle should be a clear communication between staff members and documented in the patient’s chart. This information should be shared with the entire team so that they can all work together to prevent future patient falls. The huddle should cover the following:


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