Patients have a right to a safe environment. This includes being safe from falls while interacting with that environment.
The Agency for Healthcare Research and Quality estimates that 700,000 to 1 million patients fall while hospitalized each year. Research has shown most falls are caused by a combination of risk factors. The more factors present, the greater the likelihood. One in five of these falls causes a serious injury such as a fracture or head injury.
While not every patient fall is caused by a breach in the standards of care, some of them could be.
Is Every Fall Preventable?
Fall prevention has been the focus of intense research and quality improvement efforts in the last few decades. The Centers for Medicare and Medicaid Services consider falls in a healthcare facility that result in death or serious injury to be a “never event.”
While it’s clear that many falls can be avoided, not all research agrees that every fall is preventable.
Underlying, undiagnosed medical problems can cause falls that can’t be anticipated. An example commonly mentioned is a patient with no history of a seizure disorder who falls after having their first seizure while ambulating with a nurse’s aide.
There is a strong argument to be made that this type of fall could not be prevented. However, once the seizure disorder is diagnosed, the onus is on the health care team to address this new risk and prevent additional falls.
Standards for Preventing Falls
Fall prevention protocols may vary from hospital to hospital but contain similar elements.
Team Approach. Preventing falls is the duty of all employees in a facility. We often think of this responsibility as belonging solely to the nurses and aides providing direct care, but it’s unlikely to be successful without the support of other departments—for example, environmental services who ensure dry floors and adequate lighting. Hospital administrators must provide adequate staffing and resources to carry out these interventions.
Assessment. Many validated tools are available for assessing a patient’s risk of falling. The exact tools and when they are used will vary according to hospital protocol but should be documented for staff to access.
Typically fall risk screening should be performed at every patient admission and with each status change. This could mean as often as every day or even every shift in high acuity settings. The intent is to predict which patients are likely to fall due to their health conditions and enact interventions to mitigate these risks.
Planning. Once the assessment is completed, the care team develops a fall prevention plan based on identified individual risk factors. The plan should address where the patient is most at risk (the bedside or bathroom, for example) and detail action steps like ensuring the call light is within reach, providing non-slip footwear, or a toileting schedule.
The most common mistake is prescribing one-size-fits-all interventions based on the patient’s score on a risk assessment tool. A patient at moderate risk for falls due to leg weakness will require different interventions than a moderate-risk patient with cognitive impairments.
Consistency and Communication. Simply creating a plan won’t be enough to prevent a fall. The plan must be communicated to everyone involved with the patient (including their family) and followed consistently.
This communication also includes education. The patient’s family also plays a role in preventing falls. The healthcare team should document all education provided to the patient or family members in the patient’s chart.
Revision. While a first fall might not be totally preventable, a second one most certainly is. If a patient does experience a fall, their fall reduction plan should be revisited and updated as soon as possible. The treatment team should amend the plan of care to prevent future falls. This might include changing footwear, adjusting medications, or more frequent toileting.
While not all patient falls are avoidable, many of them can be prevented. It’s not just standard practice but often a regulatory requirement for hospitals to have plans in place to reduce the risk of patient falls.
Failing to individualize, communicate, and revise fall prevention interventions likely represents a breach in the standard of care.
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