Falls Prevention can be deceptively difficult, and with the overwhelming amount of information out there, it can be hard to know where to start. That’s why we have created this Falls Prevention Knowledge Base. Here, you will find practical tips and recommendations to help prevent falls in your hospital. For further reading, we have also included a list of trusted resources with even more guidelines and tools that will empower you and your team to fight falls.

Falls Prevention Awareness

As the rate of the elderly population is rapidly increasing, so are the numbers of fall related injuries. People aged 65 years and older are considered to be at the highest risk of falling with one third of this population group experiencing a fall on an annual basis¹.

Whilst there are high costs for these patients in terms of distress, pain and loss of independence, the direct economic impact related to falls is astronomical. According to the NICE guidelines of 2013², falls are thought to cost the NHS £2.3 billion per year. When taking into account that older people living in nursing homes fall more frequently than those living in the community³, the economical significance of falls truly is staggering.

United Kingdom statistics and data of older patients who are falling over in hospitals:
UK data of older patients falling in hospital


References
¹ National Institute for Health and Care Excellence, Action needed to reduce hospital falls: a 'one size fits all' approach will not work, June 2013, Available at: http://www.nice.org.uk Accessed April, 2016
² National Institute for Health and Care Excellence. Falls: assessment and prevention of falls in older people. June 2013, Available at: http://www.nice.org.uk/guidance/cg161 Accessed 8 June, 2015
³ WHO Global Report on Falls Prevention in Older Age. World Health Organisation 2007

Patient Risk Assessment

Healthcare professionals should assess and identify patients at risk of falls and evaluate the best options to help prevent falls.

Age According to NICE, people aged 65 years and older are considered to be at the highest risk of falling¹. Around one third of this population will experience at least one fall a year at home and about half of these will have more frequent falls. In individuals over the age of 75 years, falls are the most common cause of injury related deaths in the UK.
Falls History Another critical risk factor is a history of falls, particularly if they occurred within the last six months. Previous falls are one of the most reliable predictors of future falls.
Incontinence Problems of elimination are also a key factor, especially if the person is relatively mobile and independent but experiences urgency or frequency incontinence. Frequent trips to the bathroom, particularly at night, often lead to falls. Other elimination factors such as the use of ostomy and urinary catheter supplies can add to the risk of falling.
Medications All healthcare facilities should maintain a list of drugs that can contribute to falls, including sedatives, anxiolytics, antidepressants, psychotropics, anaesthetics, antihistamines, hypoglycaemic agents, diuretics, and narcotics. Any patient who has had a recent surgical or medical procedure requiring sedation should generally be considered at high risk of falling for 24 hours post-intervention or until there is a return of the person's baseline level of consciousness.
Patient Care Equipment Another key factor is the presence of any patient care equipment that tends to tether the patient to one location or restrict movement. This may include: IVs, poles, and pumps; indwelling catheters of all types, non-portable ostomy equipment, feeding tubes, chest tubes, ventilation equipment, oxygen delivery masks, or cannulas and wired monitors.
Mobility This includes whether the patient requires ambulation assistance or a mobility device such as a walker or cane. In addition, the person's gait should be evaluated, noting if it is unsteady, lurching, swaying, or unstable.
Footwear Poorly fitting footwear may contribute to falls. A significant number of older people fall every year because of footwear that do not fit very well or have become unsafe through wear and tear. Patients should wear appropriately fitting footwear. Healthcare providers may consider slipper socks for patients with no or inappropriate footwear on admission or if footwear cannot be provided or applied. Slipper socks may also be the best option if the patient is mobile throughout the night or if a patient is not cooperating with recommended footwear.
Visual or Auditory Impairments Other issues of mobility may include visual or auditory impairments that may affect movement or cause a lack of awareness of the environment or hazards within it.
Mental Stability The risk of falling is increased if the person is emotionally impulsive, has tendencies toward being confused or disoriented, has had a stroke or has been diagnosed with a condition that can affect mental and psychological status such as Alzheimer's disease, Parkinson's disease or dementia.




References
¹ National Institute for Health and Care Excellence, Action needed to reduce hospital falls: a 'one size fits all' approach will not work, June 2013, Available at: http://www.nice.org.uk Accessed April, 2016

Environment Risk Assessment

Healthcare facilities should assess and identify environments that could cause patients to fall. Every time you enter the room be aware of factors that may make the environment unsafe (clutter, spills, cords or tubing).

Floors Floors should have non-glare and non-slip surfaces and be cleaned with non-slip wax. All patient rooms should have a clear path to the bathrooms. In general, the floor should be free of clutter.
Lighting One of the most important environmental factors to inspect is lighting in the facility. Light switches should be accessible before entering a room. Glare should be eliminated, including that from natural light coming in from the windows. In addition, lighting in dangerous areas, such as stairways and hallways, should also be scrutinised.
Patient Beds Mattresses should be extra firm at the sides to allow for secure seating and easier transfers on and off the bed. Call buttons must be easily accessible and beds should be properly configured based on a patient’s individual fall risk (consider the use of bed rails, bed height, and use of floor pads).
Patient Rooms Evaluate other patient room furniture, including chairs and bedside tables. Avoid furniture with wheels and ensure chairs allow the patient to easily lower and lift himself or herself in and out of the chair.
Bathrooms Bathroom doors should be wide enough for walkers and wheelchairs. Bathroom floors should have non-slip mats or strips to help secure footing and staff should consistently ensure the floors are dry. Grab bars should be secure and logically positioned to assist someone entering the room, getting into or out of the bath or shower and rising from the toilet. When necessary, elevated toilet seats can be used for people with a risk of falling.
Stairs Stairs should also be inspected. Handrails should be secure on both sides. Step surfaces should be non-slip and their edges should be indicated in some way, such as with a stripe of white paint or placement of reflective tape. Stairways should also be free of any clutter or equipment.
Elevators If the facility has any elevators, the elevator floor should be level with the hallway. Its surface should also be slip resistant. The door should be wide enough for walkers and wheelchairs and the emergency stop button and phone inside the elevator should be clearly marked and easy to reach.

Patient and Family Education

Once the person's risk of falling has been identified, it is important to educate the patient and his or her family about the risks and how to reduce their occurrence. Interventions and proper communication with patients or residents and family members may decrease the risk of falls. Explain to them why they are at risk of falling and what your facility is doing to keep them safe.

Educate the Patient

Explain to the patient about their risk factors and any specific information they may need, such as being aware of dizziness due to medications, illness, or weakness following a procedure. If needed, explain to the person about remaining in bed and using the call button to ask for assistance before getting out of bed, such as when they need to use the bathroom. Also suggest they wear appropriate footwear or shoes when walking to help ensure an enhanced grip on the floor.
If they can ambulate without assistance, suggest that they sit upright for 10 seconds on the edge of the bed before standing. In addition, it is important to tell them they should never try to support themselves on rolling equipment such as an IV pole. Also, explain about the use of side rails and any other protective devices. If they need adjustment, the patient should call the nurse for assistance to make the changes and try not to do this on their own.

Educate the Family

Discuss with the family members the plan of care, based on the patient's risk of falling. Educate them about the risk of injury from a fall and share what they can do to help decrease falls while the patient is in your facility. Try to empower the patient and family members with resources and support, inform them that someone will be checking frequently to assess any needs that they may have.
If a fall occurs, always communicate with the family and notify them of any suspected or confirmed injuries. This will help create a level of respect between the staff of the facility and the family. It is key to reassure the patient and family that you are taking care of them.
You can also convey a couple of key points at each visit for them to understand the risk of falling and safety precautions. Finally, you should be able to clarify any confusion and answer any questions they may raise.

Recommendations

A successful falls prevention program must be system wide and individual rules and responsibilities in falls prevention must be clearly understood by the staff. Educating and engaging the team will help build a culture of responsibility and safety within the organisation. It is important to provide the staff with falls prevention tools to help support their initiatives to increase awareness and reduce falls in the facility. Education components needed for falls prevention should be established into new employees' orientation as well as yearly competencies for all staff. Educate your team on a regular basis in order to create an environment which will improve the quality of life of the patients.

Engage the Team

  • Help staff identify areas considered as high risk for falls
  • Implement trainings and learning activities for the staff
  • Ensure that falls prevention is placed on the staff meeting agenda as a routine topic to discuss with all staff (share data, ask for recommendations to improve the program)

Falls Prevention Tools

Teach the staff about falls prevention tools that are specific to the falls prevention program of the facility, for instance:

  • Debriefing tool or investigation tool: used for interviewing staff that may have been present when the fall occurred. It gathers data that can be used for future educational needs of the team and staff in general
  • Comfort rounds/rounding tools: when patients are checked frequently; the needs of the patients are better met. Hourly rounding is essential to help falls
  • Dashboard tool: used to help track what is going on in the facility regarding falls from the past and present and help the team implement, plan and improve care for the future
  • Bed alarm is often used to alert staff of significant movements in the bed which could lead to a fall
  • Personal equipment including having the urinal within reach of the patient
  • Use of anti slips socks

Debriefing

Once a fall has occurred, the nurse should:

  • Interview the patient as soon as possible 
  • Evaluate clinical condition and risk factor
  • Investigate possible environmental factors that may have contributed to the fall 
  • Assess equipment
  • Define/implement interventions consistent with patient goals/standard of practice
  • Interview staff
  • Documentation
  • Monitor/evaluate impact of interventions
  • Revise interventions

Implement a Visual Cueing Protocol

Preventing falls is everyone’s responsibility, but how can your staff participate in the fight against falls without knowing whom they should be looking out for? Choose products in a bright color, like yellow, to help caregivers quickly, yet discreetly, identify patients at a high risk for falls.

Through visual cueing, nurses, healthcare assistants, porters, housekeepers, catering staff can all play an important role in reducing the number of patient falls. As yellow is the most commonly used colour for identifying high-risk patients, Medline has developed an exclusive range of yellow falls prevention products to help you easily introduce visual cueing at your hospital.

Resources

NHS Improvement - Patient falls improvement collaborative: 

Royal College of Physicians:

NICE clinical guideline:

HOPE - European Hospital and Healthcare Federation:

WHO – World Health Organization:

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