Each volunteer spends 5-10 minutes visiting each patient every Monday, Wednesday, and Friday to review the fall prevention handout. Which other factors to consider beyond the standardized tool depend on clinical judgment and unit-specific policy.Some tools that assess risk factors for falls also include a scoring system to predict risk for falls, and many facilities plan care according to the amount of risk (according to high, moderate, and low risk, for example).
The responses to these risk factors need to be different. For example, patients may need to cooperate with using appropriate footwear or using the call light when they need help. These can change over time while a patient is in the hospital. As you read through this section, think about how you can integrate your fall prevention program with the variety of acute medical treatments that your hospital must deliver.Another key point to remember is that fall prevention alone cannot be the goal of a fall prevention program.
The care plan needs to be reassessed when a patient's risk factors are reassessed and are found to have changed. Trying to apply the same care plan to all "high risk" patients may distract staff from implementing the elements of the care plan that actually address each individual patient's risk factors.For these reasons, we think the most important application of an assessment tool is to identify fall risk factors for which care plans can be developed. The care plan is an active document. After a fall occurs and the patient's root cause analysis is complete, a safety huddle (go to With frequent handoffs between hospital personnel, whether it be nursing staff who change shift every 8 hours, or hospitalists who rotate every week and have separate night or weekend coverage, communication is critical. An understanding of the events surrounding a fall can inform the care plan for the patient who fell, as well as guide ongoing quality improvement efforts at the unit level.
Other scales may be used instead of the Morse Falls Scale or the STRATIFY. Falls can be classified into three types:For more information, see Morse JM, Tylko SJ, Dixon HA.
These rooms are designated for cognitively impaired patients requiring (1) closer supervision, and (2) specialty equipment and activities.Safety zone room equipment includes low beds, mats for each side of the bed, night light, gait belt, and a "STOP" sign to remind patients not to get up. These include the emergency department, observation units for patients staying less than 24 hours in the hospital, and radiology. Each component of the fall prevention program is critical and each must be consistently well performed. A safety huddle is a short, informal meeting to cover issues related to patient safety. One large trial of bed alarms failed to show a benefit for prevention of falls.Some hospital units have designated areas for patients at high fall risk. The hospital's first priority is acute medical care; patients come to the hospital because they are ill and their primary purpose is to receive treatment for their illness.The goal of patient safety practices like fall prevention is to prevent additional harm to patients while they are hospitalized. Once you determine that you are ready for change, the Implementation Team and Unit Team need to state their plans for implementing best practices. These updates also need to be followed up by a change in your actual care practices for the patient.Sometimes, putting together all the discrete parts of a care plan based on patient risk factors can be akin to putting together a puzzle. For thorough coverage of options to prevent fall-related injuries, go to the VA Sunshine Healthcare Network (VISN 8) Patient Safety Center of Inquiry Web site at Patients and their families should understand the patient's fall risk and how the proposed care plan addresses this risk. (Hourly rounding is typically defined as hourly visits between 6 a.m. and 10 p.m. and visits every 2 hours between 10 p.m. and 6 a.m.; go to Hourly rounding can be carried out by a nurse alternating with a nursing assistant (such as a certified nurse assistant, patient care technician, or nurse's aide). Other units may have patients whose needs fluctuate rapidly or involve frequent patient transport. In addition, patients may be required to change beds within the unit or be transferred to a new unit. It needs to incorporate the patient's response to the interventions as well as any changes in his or her condition.The care plan indicates specific actions that should, or should not, be performed. There are multiple risk factors for falls, and different patients may have different combinations of risk factors.
Patients are not disturbed if sleeping, except as needed to provide care. An oral handoff to the treating medical provider is therefore essential.Careful documentation and communication of your root cause analysis are critical to preventing future falls in the same patient.
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fall prevention interventions