A patient in the hospital is often sick, weak, taking new medications, recovering from surgery, or in unfamiliar surroundings. Something as ordinary as getting out of bed to use the bathroom can result in a serious fall.
That is why hospitals need rules and procedures designed to identify patients who are at risk of falling and take reasonable steps to protect them.
Identifying the Risk
Fall prevention should begin with the patient.
Hospitals commonly use fall-risk assessments to help identify patients who may need additional protection. One widely used tool, the Morse Fall Scale, considers such things as whether the patient has fallen before, whether the patient needs a cane or walker, the patient’s ability to walk and transfer, and whether the patient understands his or her own limitations.
But identifying a patient as a fall risk is only the beginning. The important question is: What is going to be done about it?
A Fall Prevention Plan Should Fit the Patient
Different patients fall for different reasons. A patient who is confused may need different precautions than someone who is alert but physically weak.
Once the risks are identified, the hospital should develop a prevention plan based on that particular patient’s needs. Research supports individualized plans that address the patient’s specific risk factors rather than relying on the same precautions for everyone.
Depending upon the patient, precautions may include:
- helping the patient get out of bed or walk;
- keeping a walker or other needed equipment within reach;
- keeping the room and walking areas free of hazards;
- assisting with trips to the bathroom;
- appropriate supervision;
- educating the patient and family about the risk of falling; and
- making sure everyone caring for the patient knows the fall prevention plan.
Communication is particularly important. Research on hospital fall prevention has found that inconsistent communication among the care team can be a major barrier and that nurses, other caregivers, patients, and families need to work together.
Rules Matter Only When They Are Followed
A fall-risk score or a “Fall Risk” sign does not protect a patient by itself.
The hospital must take the information it has about the patient and turn it into action. The prevention plan must be communicated and consistently followed by the people actually caring for the patient. If the patient’s condition changes, the risks and precautions may need to change as well.
If a fall does occur, the hospital should also determine why it happened and address the cause so that another fall can be prevented.
Falls and “Never Events”
The Centers for Medicare & Medicaid Services, or CMS, has taken special steps to address preventable injuries that occur in hospitals. CMS includes falls and trauma among its selected hospital-acquired conditions, including injuries such as fractures, dislocations and intracranial injuries.
Falls resulting in death or serious injury are recognized by CMS as “never events,” a term commonly used to describe serious reportable events that are generally identifiable, usually preventable, and may indicate a problem with a healthcare facility’s safety systems.
The designation of a fall as a “never event” does not mean that every hospital fall is preventable or that the occurrence of a fall automatically means someone did something wrong. Rather, it emphasizes the responsibility of healthcare organizations to establish, implement, and consistently use effective safety systems and evidence-based practices to reduce the risk of falls and prevent serious, avoidable harm.
Preventing the Fall Before It Happens
When a patient falls in a hospital, one of the most important questions is not simply how the patient fell, but what was known beforehand.
Was the patient recognized as being at risk? Was a prevention plan developed? Did the plan address that patient’s particular risks? Was it communicated to everyone caring for the patient? Most importantly, were the precautions actually followed?
Fall prevention begins with recognizing the danger and taking reasonable steps to protect the patient before the fall occurs.