What is fall prevention?
Fall prevention in healthcare involves managing patients' underlying risk factors and optimizing their environment to reduce the likelihood of an unplanned descent to the floor. Resources such as Fall Prevention Toolkits have been shown effective in reducing this type of patient safety event.
A hospital is an unfamiliar setting, and every patient is there because of an illness or condition that requires treatment. It's a recipe that increases the likelihood of falls, one of the most common and most devastating events in any hospital setting.
While the rate of falls varies among hospitalized adult patients depending on the study, multiple studies indicate that 3-4 falls occur per 1,000 bed days.
A fall, especially by a geriatric patient, can be the start of a downward spiral as described by the team that did early research on the use of a fall prevention toolkit. A single fall can have compounding effects and result in fear of falling, reduced mobility, loss of function and greater risk of falls."
That early research, published in the Journal of the American Medical Association in 2010, found a significantly reduced rate of falls in the hospital setting when a toolkit was added to usual care protocols. Over the next decade and funded through a grant by the Agency for Healthcare Research & Quality, that research team would go on to further refine their toolkit to help facilities prevent falls. And the toolkit resulting from all that work — Fall Tailoring Interventions for Patient Safety (Fall TIPS) — was recently released for free.
In another JAMA study including more than 37,000 patients published in 2020, the Fall TIPS toolkit was tested at Brigham and Women’s Hospital in Boston and 2 other facilities, finding that falls with injury were reduced by 34% while total falls decreased by 15%. Since then, more than 100 hospitals in the U.S. and internationally have used the toolkit.
Choosing a Modality: Paper vs Electronic
When Fall TIPS was first developed, use of the nurse-led, evidence-based toolkit proved to reduce falls by 25% in acute care settings when implemented as part of electronic record-keeping. The Fall TIPS team then set out to create a "low tech" tool that offered the same benefits in preventing falls, the end result being an 11"x17" laminated poster on which the personalized plan for each patient is marked.
In the EHR version, the patient’s risk factors and tailored interventions automatically populate the Fall TIPS electronic poster, which a nurse then prints and hangs in the patient’s room. While the integration into a facility’s EHR reduces the potential for error, it also requires the involvement of the IT team to set up. The lower-tech, laminated poster version, on the other hand, can easily be filled out with a dry erase marker and updated daily at the bedside. (A full list of the pros and cons of the paper and electronic methods can be found on the Fall TIPS site under the heading “Paper or Electronic?”)
Whether a high- or low-tech solution is implemented, the goal is to use bedside tools to communicate current and changing patient risk factors, so all stakeholders have access to the information needed to engage in prevention activities.
Measuring Success and Evaluating ROI
The human cost of falls is not the only cost. One-third of falls result in injury, and injurious falls can add a week or more to a hospital stay. The same JAMA study from 2020 found that the additional cost was $19,376 to $32,215. And these costs are not reimbursed by the Centers for Medicare & Medicaid Services because most (more than 90%) of falls are preventable.
When implementing a performance improvement tool like Fall TIPS, it’s always a best practice to start by ensuring you can track and measure success for communication to the team on the frontline as well as senior leadership. The best way to accomplish this is through a Patient Safety Event Reporting Application with real-time dashboards. If your tool has a dedicated Falls Dashboard like ADN’s application (see video below), evaluating falls data pre- and post-implementation of a tool like this is much easier.
Implementing The Toolkit and Establishing Buy-In
At the patient level, Fall TIPS is a three-point plan of action:
- Fall Risk Screening/Assessment
- Tailored/Personalized Prevention Planning
- Consistent Execution of Plan
The toolkit is easy enough to use that compliance was above 80% at the hospitals where it was first tested. So with administrative buy-in and training of patient-care staff, Fall TIPS can become a routine and effective part of patient care. (Subsequent research by the Fall TIPS team showed that a compliance rate of at least 80% is necessary to achieve a clinically significant reduction in falls.)
A poster in the patient's room is the most visible tool in the toolkit (either the laminated version or the EHR printout). But implementation starts at the top with administrative support. That should include engaging any relevant committees and champions. Some organizations may already have a specific fall-prevention task force, or the appropriate body might be a general quality and safety council. Buy-in needs to come from within the existing organizational structure.
Implementation also includes analyzing existing fall-prevention protocols to see how much overlap there is with the best practices. The toolkit includes a tool to assess gaps in protocols, as well as an implementation checklist and training materials for champions and nurses. (To get started implementing Fall TIPS, click here.)
Risks and Interventions
Whether using the high- or low-tech version of Fall TIPS, the result is a personalized assessment of the patient's risk of falling and a personalized plan to address their specific risk profile.
Does the patient have a history of falls? Are they taking medications that might contribute to unsteadiness? Do they already use a cane or walker? Are they likely to get out of their bed or chair without summoning help?
Once the patient's risk factors have been committed to the record, interventions to mitigate those risks can also be committed to the care plan. Is a bedpan appropriate, or should the patient be assisted to the toilet? How many helpers does the particular patient need? Is the risk of getting up unassisted so great that a bed alarm is required?
All of the risk factors and interventions should be discussed with the patient and with family members so that everyone involved understands the plan for preventing falls. In fact, whether the patient and/or family can verbalize the patient's risk factors and the fall-prevention plan are part of the audit questions that internal champions must answer.
Patient and family feedback has affirmed that knowing the plan improves compliance and can help reduce the fear of future falls, a factor in the downward spiral of fall-prone patients.
Responsive to Changing Conditions
Fall TIPS is not a one-size-fits-all plan for every patient, nor is it static for the individual patient. It can be customized as the patient's condition changes. The patient's risk factors and appropriate interventions should be re-evaluated daily. The poster features an assessment date so that every care provider can see how current the evaluation is.
A patient may, for instance, be at greater risk of falling and need different levels of assistance immediately after surgery than before. A change in medications may also change risk factors and the interventions needed. With training and consistent use, Fall TIPS can reduce the number of patient falls and reduce the number of injuries associated with falls that do happen.
Learn more about how ADN’s Patient Safety Event Reporting Application can help you uncover trends and patterns about falls in your event data.
About American Data Network
For more than 25 years, American Data Network (ADN), which is also the parent company to its Patient Safety Organization (ADNPSO), has worked with large data sets from various sources, aggregating and mining data to identify patterns, trends, and priorities within the clinical, financial, quality and patient safety arenas. ADN developed the Quality Assurance Communication (QAC) application, with which hospitals, clinics, rehabs, and other providers record and manage patient safety events. By entering events into ADN’s QAC application and submitting them to ADNPSO, information is federally protected and thereby privileged and confidential. These protections provide a safe harbor to learn from mistakes and improve patient safety.