Reducing In-Hospital Patient Falls

Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. But it's an issue where identifying the best ways to prevent them—especially within the confines of a healthcare organization—can be quite challenging.
In a hospital, a typical fall rate in general and med-surgical units would be considered about four to five falls per 1,000 patient days, or about a fall per day in a 250-bed hospital, says Ronald I. Shorr, MD, director of the Geriatric Research Education and Clinical Center at the Malcom Randall VA Medical Center and professor at the University of Florida Department of Aging and Geriatric Research, both in Gainesville, FL. About a third of those falls will result in injury, although only 2% of those injuries will be severe.

Generally, two types of "fallers" can be found in the hospital: frail patients and those patients who don't want to bother the nurse, according to Shorr. Injury, though, may be equal in both groups because frail individuals often know "how to fall" compared with their younger counterparts.

Providers are finding some success through efforts such as installing alarms, designing rooms with bathrooms closer to the bed, targeting the timing of certain medication administration, regularly updating fall-risk assessments that are communicated to the care team, and talking about falls with patients, whether they are hospitalized or not. It also means evaluating patients as they proceed through a continuum of care after they leave a hospital.

But the overarching problem appears to be that "we can't find a magic prediction rule that appears to discriminate between people falling and people who fall and injure themselves," Shorr says. "The problem is that most hospital patients are moderate fall risks. If you walk around a hospital, you will find stickers indicating risks of falling on probably 70% of all doors."

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