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Fall Prevention Assessment: Is Your Patient At Risk?

Fall Prevention Assessment: Is Your Patient At Risk?

An estimated 84% of adverse events in hospital patients are due to falls, which can complicate recovery. In fact, 25,500 Americans died from falls in healthcare settings in 2003.1 How can you keep your patients safe with these worrisome statistics?

What is a fall?
What are the types of falls?
What is the difference between intrinsic and extrinsic fall risks?
Are your patients at risk for falls?
What is a fall risk assessment or screening?
What fall risks are typically considered during a fall risk assessment?
What can you do to reduce your patients’ risk of falls?
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What is a fall?

Agreeing on what defines a fall is the first step to consistent fall monitoring and prevention. Merriam-Webster defines the word fall as "to leave an erect position suddenly and involuntarily."2

One widely accepted definition of a patient fall is "an unplanned descent to the floor with or without injury to the patient."1

What are the types of falls?

Falls are typically classified into three types in risk assessments and fall guides.

1. Anticipated Physiological Falls

  • Falls caused by expected physiological factors, including unstable gait, a history of falling, altered mental status, frequent toileting needs, and certain medications.

2. Unanticipated Physiological Falls

  • Falls caused by unexpected physiological factors, including seizures, syncopal episodes, and delirium.

3. Accidental Falls

  • Falls caused by slipping, tripping, and other usually extrinsic factors.

What is the difference between intrinsic and extrinsic fall risks?

Some clinicians and hospitals divide fall risk factors into two groups, intrinsic and extrinsic.

  • Intrinsic Fall Risks

    • Risks that originate within the patient, such as low blood pressure, impaired mobility, impaired vision, or foot pain/paresthesias.
  • Extrinsic Fall Risks

    • Risks that originate outside the patient, such as slippery floors, poor lighting, or an uneven threshold.

Are your patients at risk for falls?

Falls occur in approximately 3% of hospitalized patients, but 38-77% of falls can be anticipated.2,3 This means that you can make a plan to reduce falls in patients who have a high fall risk. Proper fall risk screening and assessment is a crucial part of deciding if your patient is at risk for falls.

What is a fall risk assessment or screening?

Some people use the terms ‘fall risk screening’ and ‘fall risk assessment’ interchangeably. Others use ‘screening’ as the first step to assessing fall risk and determining if a patient is at risk and ‘assessment’ as the second more in-depth step that looks at causes and interventions in a specific patient.

A fall risk assessment is a screening tool used to predict your patient’s risk of falling. The tool is typically used at every patient admission, after transfer to a new unit, after a change in level of care or patient status, and after a fall. The assessment tool typically uses a scoring system that adds up points corresponding to the cumulative effects of known risk factors.

There are several screening tests available including the Morse Fall Scale, Schmid Fall Risk Assessment Tool, STRATIFY Fall Risk Assessment Tool, and the John Hopkins Fall Risk Assessment Tool. Different hospitals select different tools depending on what they believe will provide the most accurate prediction of future falls.

What fall risks are typically considered during a fall risk assessment?

  • Age

    • Older patients are typically at a higher risk for falls. Some assessments assign increasing point values if the patient is over 60, over 70, and over 80.
  • Previous Fall History

    • If your patient has fallen in the past six to twelve months, they are at a higher risk to fall again. If they have fallen multiple times, they may be considered a high fall risk.
  • Gait Instability

    • Difficulty walking due to impaired mobility or lower limb weakness, often due to illness, inactivity, age-related challenges, or conditions that affect gait and balance, like Parkinson’s disease, can increase your patient’s fall risk. Your patient is also at a higher risk for falls if they use a mobility device.
  • Urinary Incontinence, Frequency, or Need for Assistance

    • Medications and I.V.s can increase urinary urgency and frequency. Some patients may get up quickly or walk without assistance to avoid urinary incontinence, leading to falls.
  • Medication

    • Medications and their side effects may put your patients at a higher risk for falls. Sedatives, diuretics, opioids, anticonvulsants, psychotropics, and other medications may cause dizziness, unsteadiness, postural hypotension, and other effects that increase fall risks. If your patient is on multiple medications, their interaction may also increase your patient's fall risk.
  • Patient Care Equipment

    • Patients tethered to I.V.s, chest tubes, catheters, etc. are at a higher risk for trips and falls.
  • Altered Mental Status

    • Patients who are agitated, confused, or lack understanding of their physical and mental limitations may get out of bed without assistance (when it's needed) and are at a higher risk of falling out of bed.
  • High Risk of Injury, Evaluated Using ABCS

    • Age: If your patient is over 85 years old, increases in frailty increase their risk of injury.
    • Bones: Osteoporosis or a history of fractures increases your patient's risk of a broken bone after a fall.
    • Coagulation: Anticoagulation medications, low platelet counts, and other conditions can put patients at a high risk of bleeding after a fall.
    • Surgery: Recent surgery, including lower limb amputation and abdominal or thoracic surgery also increases a patient’s risk of injury after a fall.

What can you do to reduce your patients’ risk of falls?

If your patient is at a high risk for falls, having both universal fall precautions and fall prevention care tailored to individual patients can help keep them safe. Here are a few suggestions to reduce your patients’ risk of falls.

Universal Fall Precautions

  • Familiarize your patient with their environment and how to use the call light
  • Keep your patient’s personal belongings and call light within reach
  • Have sturdy grab bars or handrails in the patient’s room, bathroom, and hallway
  • Keep the hospital bed low when the patient is resting and raise the bed when transferring
  • Keep brakes locked on hospital bed and wheelchair when they are stationary
  • Make sure your patient is wearing non-slip footwear at all times
  • Use nightlights
  • Keep floors dry and clear of clutter, clean up any spills promptly
  • Follow safe patient handling guidelines

Patient-Specific Fall Precautions


If your patient has…

  • A previous fall history
    • Learn the circumstances of the past fall and create specific interventions to prevent a similar fall
  • Gait instability/lower limb weakness
  • Urinary incontinence
    • Follow a toileting schedule
    • Hourly rounding by a nurse or nursing assistant
    • Incontinence briefs and draw sheets
  • Altered mental status
    • Continuous monitoring using bed or chair alarms
    • Frequent rounding
    • Floor mats to reduce injuries from falling out of bed
    • Assess for alcohol or drug withdrawal and follow protocol if needed
  • Medications
    • Consult a pharmacist about medications
    • Assess medication side effects, like dizziness, and develop a management plan

Creating a Laminated Fall Prevention Poster

A laminated poster like the one below can be used to communicate the risks and interventions of falls to patients.

The poster can serve as a reminder to patients, family members, and hospital staff. Go over the poster with your patient and use a dry erase marker to make your selections.

Prevent Patient Falls Poster

Download your free copy of a "Prevent Patient Falls!" sheet to share with your patients.

Learn More

Find out more about reducing patient falls, including equipment to reduce falls and how to prevent patient falls once they head home and leave your care, in this article on fall prevention.

References

  1. Lunsford, B. and Wilson, L.D. (2015). Assessing Your Patients’ Risk for Falling. Retrieved from https://bit.ly/2OKjsU9
  2. Merriam-Webster. (n.d.). Fall. Retrieved from https://bit.ly/2KBMq38
  3. Dykes, P.C., Adelman, J., Adkison, L., et al. (2018). Preventing Falls in Hospitalized Patients. Retrieved from https://bit.ly/2Ngsffb
  4. Agency for Healthcare Research and Quality. (2013). Preventing Falls in Hospitals. U.S. Department of Health & Human Resources. Retrieved from https://bit.ly/2Nak4N9

Medical Disclaimer: The information provided on this site, including text, graphics, images and other material, are for informational purposes only and are not intended to substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other healthcare professional with any questions or concerns you may have regarding your condition.