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Falls (Acute Care), Prevention of

Protocol Summary

Revision Date: April 2012
Third Edition

Scope and Target Population

This protocol will include recommendations for a risk assessment for falls in hospitalized patients, and will focus on the strategies and interventions required for the prevention of falls and eventual elimination of falls with injury in acute care settings. The target population is adult patients in an acute care setting.

Aims

  1. Eliminate all falls with injury through a falls prevention protocol in the acute care setting.
  2. Increase the percentage of patients who receive appropriate falls risk assessment and falls prevention interventions.

Clinical Highlights

  • Best practice results have only been achieved when there is significant organizational support for falls reduction across departments and disciplines.
  • Transparency of falls rates by sharing between hospital units, hospitals and hospital systems or public reporting has a positive effect on falls and injury reduction.  
  • Accountability through auditing of compliance with falls risk assessments and interventions has a posi-tive effect on reducing falls rates and injury (consensus of panel members).
  • Best practice in falls reduction includes:
    • falls risk assessment
    • visual identification of individuals at high risk for falls
    • falls risk factor directed interventions
    • standardized multifactorial education including visual tools for staff, families and patients.
    • Teach back – a method of patient education that includes scripting such as "just to make sure I did a good job in teaching you how to prevent a fall while you are here, can you tell me the most important thing you can do to prevent a fall?"
  • There should be interdisciplinary collaboration on falls prevention at the time of admission between admitting clinicians having first contact with the patient, including admitting physicians, pharmacists and nurses.
  • Incorporate team-based success factors associated with the best reported reductions in falls and injury rates including:
    • Ensuring falls risk assessments, investigation of falls incidents, confronting problem issues, and accountability for missed opportunities.
    • Interdisciplinary discussion of patient falls risk during daily rounding.
    • Medication review for all patients at risk for injury and/or risk for falls.
    • Nurse rounds to include reinforcement of education patients/families role in falls risk prevention (use of call light, assist with ambulation to bathroom, etc.).
    • Implementation of interdisciplinary post-fall huddle to discuss action plan after patient fall event.
  • Falls risk assessment (regardless of age) should include:
    • a determination through the use of an assessment tool that the patient has fallen in the past year,
    • a functional assessment test
    • visual observation of the patient's mobility for those not confined to bed rest, and
    • an injury risk assessment.
  • Acute care settings should implement a visual identification system for patients at risk of falling.
  • Communication of falls risk across departments and disciplines (including to attending physicians) should be reliable.
  • Multifactorial interventions that increase observation and surveillance have been found to be effective on falls.