Patient falls are the most common adverse event reported in hospitals, affecting an estimated 700,000 to one million patients in the United States each year. Falls can lead to injuries, including fractures and head trauma, increasing the patient’s length of stay and the overall cost of care. Preventing hospital falls requires a coordinated effort among clinical staff, the patient, and family members to maintain a safe environment. Effective prevention programs are individualized to address the specific vulnerabilities of each person under care.
Identifying Patient Risk Factors
Hospital staff begin the fall prevention process by systematically identifying which patients are most likely to experience a fall during their stay. This is accomplished using standardized assessment tools like the Morse Fall Scale or the Hendrich II Fall Risk Model, which evaluate a patient’s intrinsic risk factors. One of the most significant predictors is a history of previous falls, which immediately flags a person for higher surveillance and targeted interventions.
Healthcare providers also conduct a thorough review of medications that can alter a patient’s physical or mental state, such as sedatives, diuretics, or certain blood pressure drugs. These pharmaceuticals can cause side effects like dizziness, confusion, or a sudden drop in blood pressure upon standing, known as orthostatic hypotension, which directly contribute to instability. Impaired mobility is another major factor, which includes problems with a person’s gait, balance, or the need for assistive devices like canes or walkers.
Cognitive status is routinely assessed, as conditions like acute confusion or delirium can lead to poor judgment and attempts to get out of bed unassisted. Additionally, patients with visual impairments or sensory deficits may struggle to navigate an unfamiliar hospital room, especially during the night or when temporarily disoriented. Hospitals use the results from these assessments to assign a risk score, which then guides the creation of a personalized fall prevention plan implemented by the nursing staff.
Patient and Family Roles in Prevention
The patient and their family are active collaborators in the fall prevention plan. The most important action a patient can take is to consistently use the call light to request assistance before attempting to get out of bed or a chair. This is crucial when needing to use the restroom, as a large percentage of falls occur during unassisted trips to the bathroom.
Patients and family members should communicate any sudden changes in the patient’s condition to the nursing staff without delay. This includes reporting lightheadedness, dizziness, sudden pain, or increased confusion, as these symptoms signal an immediate spike in fall risk. Waiting for a nurse’s help before standing up is paramount, especially after receiving new medications or following a procedure that may have temporarily weakened the body.
Proper footwear provides another layer of protection. Non-slip socks, often provided by the hospital, or sturdy, well-fitting shoes with non-skid soles should be worn any time the patient is out of bed. Slippers without gripping soles or loose-fitting footwear have been associated with a higher incidence of falls.
When a family member or visitor is present, they should ensure the patient’s personal items, such as glasses, water, or the phone, are placed within easy reach to eliminate the need for the patient to stretch or lean. Family members can also help by orienting the patient to the immediate surroundings, pointing out the location of the call light and the shortest path to the bathroom.
Ensuring a Safe Hospital Environment
Hospitals implement physical protocols to modify the patient’s environment and mitigate fall risks. A standard practice is ensuring the patient’s bed is kept in the lowest possible position, except when staff are actively providing care or assisting with transfers. The wheels of the bed must also be locked firmly to prevent any unexpected movement when the patient is getting in or out.
For patients identified as being at an extremely high risk for falls, the hospital may employ specialized technology, such as bed or chair alarms. These devices use pressure sensors to alert staff immediately if a patient attempts to get up without assistance, allowing caregivers to intervene quickly. However, the effectiveness of these alarms is often debated, with some studies finding limited evidence that they reduce overall fall rates.
Hospital staff are trained to manage the room setup to eliminate potential tripping hazards. This includes ensuring that pathways are clear of medical equipment, power cords, and personal belongings. The patient’s mobility aids, such as a walker or cane, must be kept within immediate reach and confirmed to be in good working order.
Adequate lighting is maintained to help patients navigate safely, especially during the night. Many facilities use nightlights or low-level ambient lighting to prevent disorientation when a patient wakes up to use the restroom. The goal of these environmental modifications is to create a safe, predictable space that supports the patient’s mobility while minimizing the risk of an unassisted fall.