The challenge with trying to address falls is not that we don’t have a variety of strategies. We actually have quite a few. They range from the very simple to quite challenging and labor intensive. A variety are listed below.
- Conduct Thorough Fall Risk Assessments: Valid and reliable fall risk assessments should be conducted with every patient. Early identification of patients at risk for falls supports the timely initiation of prevention interventions. The FHMMC uses a Modified Morse Scale for fall risk assessment upon admission (https://www.selfregional.org/wp-content/uploads/2015/11/Fall-Prevention.pdf). This can be done at admission and at key points during the hospitalization. Recognize as well, that the process of treating people with a variety of medications as well as placing IV lines, foley catheters and other invasive devices will increase the chances that a patient will fall.
- Implement Evidence-Based Fall Prevention Algorithms: The Centers for Disease Control and Prevention (CDC) created the Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative, which offers solutions for fall risk screening, assessment tools, diagnostic testing, and referral recommendations. https://www.cdc.gov/steadi/index.html
- Educate Healthcare Professionals and Patients:
- Provider Education: Healthcare providers should be educated about falls, their causes, and evidence-based prevention strategies. The medications as well as the various IV’s and other “tubes” left in patients, increase the risk of falls. We routinely make otherwise reasonably stable people into fall risks because of the medications and various devices that we attach to them.
- Patient Education: Engaging patients and families in the fall prevention process and providing them with education is crucial. Providing patients with information like “Prevent a Fall Tip Card” upon admission can be beneficial. Discussing the plan with the patient and their family on a regular basis may help keep them engaged.
- Develop Tailored Fall Prevention Care Plans: Based on risk assessments, personalized action plans should be designed to reduce the likelihood of falls through tailored interventions. One size fits all solutions will not be adequate to the varied reasons that patients are at risk for falls.
- Consider the use of Remote Video Monitoring: There is some evidence that the use of remote monitoring may reduce fall risk. Though the implementation may still require some effort. https://www.sciencedirect.com/science/article/pii/S2666273623002826#:~:text=The%20shortage%20of%20healthcare%20professionals,patients%20and%20healthcare%20professionals%20alike
- Provide Ongoing Feedback to Staff and Leadership: Regular feedback allows for adjustments and improvements in fall prevention workflows, communication, teamwork, and care customization. Track fall rates in units as well as whether appropriate fall evaluations are being completed – use of daily management boards allow for huddles and visual data.
- Consider Environmental Factors: Addressing environmental causes of falls such as clutter, wet floors, inadequate lighting, and difficult-to-use assistive devices is important. (This is true for patients who may remain frail at discharge – evaluation of the home for things that increase the chance of falls is valuable).
- Address Physiological and Medication-Related Risks: Underlying causes of falls like balance issues, metabolic disorders (e.g., diabetes), frailty, sarcopenia, vision impairment, and medications should be addressed. Medications that should be used with caution in the elderly population were updated in the American Geriatrics Society guidelines in 2015. Medication reconciliation is a formal process to ensure accurate medication information transfer and can help prevent adverse drug events related to falls.
- Promote Interprofessional Collaboration: Include other members of the healthcare team in employing evidence-based algorithms to prevent falls. Health care professionals such as podiatric physicians and eye care professionals can play a crucial role. Consults may be used in the hospital or referrals once the patient is discharged home. Daily huddles with the team may also help direct strategies that would address changes in the status of patients and allow the team to adapt or add more specialties to the team that is caring for the patient.
- Conduct Regular Purposeful Rounding: Implementing purposeful rounding (e.g., the 5 Ps – Potty, Pain, Position, Proximity, Prevent falls) every two hours can help mitigate fall risks by regularly addressing the patient’s environment. Ensure that all staff understand that if a patient calls for help, everyone should check on the patient. Don’t wait for the assigned staff member to respond.
- Utilize Quality Improvement Methodologies: Implement quality improvement projects using evidence-based strategies like the Master Clinical Pathway for Inpatient Falls (MCPIF) toolkit. Aim for continuous improvement and align fall prevention efforts with High-Reliability Organization (HRO) principles. Try to determine that the system is functioning as intended and always learn from episodes when falls occur.
- Foster a Culture of Safety: Create a healthcare environment where safety is a priority, teamwork is valued, and individuals feel comfortable speaking up about safety concerns without fear of reprisal. Addressing hierarchy in healthcare teams can improve communication and patient safety. Strategies to mitigate errors, such as closed-loop communication and team monitoring, should be discussed and taught.
- Implement Post-Fall Management: Falls will happen. Understanding why the fall occurred and remediating the cause through post-fall management is important for continuous improvement. Use these events to improve your systems.
- Monitor and Evaluate Programs: Continuously monitor fall rates and the effectiveness of implemented strategies, making adjustments as needed then reassess those changes.
A few things have been a surprise to me in looking at ways to reduce falls. Use of non-slip socks has not clearly proven to be as helpful as you might expect. It may be just as helpful to use the slippers that patients wear at home. Socks can get twisted around and may not be what patients are used to. Ask families to bring in the slippers people wear at home, so they know how to put them on and use them. Also, use of bed alarms may not be as helpful as you might think. When people believe there is an alarm to warn them of patients getting out of bed, it may reduce the opportunities to just walk around and check on patients because people believe the technology is better than the people.
The approach to the issue of falls will not likely improve with a single intervention. Rather, a combination of a few of the above strategies that make the most sense within your system and with your leadership. Choose a few strategies that make the most sense for your staff and focus on doing those really well.