UTHCPC Procedures - Fall Prevention/Intervention Strategies

The most common approach to fall prevention is the use of a program of multiple interventions that aims to minimize the patient's risk of falling. The following summarizes these interventions, representing best-available evidence based on expert opinion.

Some form of assessment of a patient's risk of falling was utilized in most studies, particularly in the following situations:

On admission to the hospital

All confused and elderly before settling at night

Post operative patients

All elderly on prescribed analgesics, sedatives, anti-hypertensive, etc

Some studies have specifically targeted high-risk patients in the following ways:

Incorporating a problem such as "At Risk of Falling" or "Potential for Injury" in the patient's records and charts.

Implementing a clinical treatment and rehabilitation program to reduce falls (if applicable)

Interviewing all patients within 24 hours of a fall to assess the patient's risk and to plan their rehabilitation.

Educational activities were a common component of fall prevention programs, and examples of how this has been utilized include:

Staff training to increase awareness of high risk patients and prevention strategies

Educating the patient and family about the risk of falling, safety issues and their mobility limitations

Teaching patients to make position changes slowly

Orientating patients to their bed area, ward facilities and how to get assistance

Education programs for all new and high risk patients

Decreasing environmental risks, obstacles and clutter

Install anti-slip tape/strips

Ensure walk areas have adequate lighting

Stabilizing beds and bedside furniture

Having grab bars near toilets which are fitted vertically rather than in a horizontal position

Alarms or call bells

Interventions to support the patient's elimination needs were common to many programs of fall prevention, and include:

Placing patients with urgency near toilets

Checking patients who are receiving laxatives and diuretics

Toileting at risk patients routinely

Instructing male patients prone to dizziness to void while sitting

Reviewing prescribed medications frequently (e.g., antihypertensives, antidepressants)

Checking patients receiving laxatives and diuretics

Limiting combinations of medications when possible (e.g. sedatives, analgesics, etc)

Non-skid footwear

Providing physical therapy

Instructing patients to rise slowly

Walking high risk patients

Repeating activity limits to patient and family

Altered mental status was the most commonly identified risk factor for falling and interventions used in studies to address this problem include:

Re-orientating confused patients

Orienting patients to the hospital environment

Moving confused patients near nurses station

Using family members to sit with confused patients

Provide low bed positioning for confused

Interventions that aim to reduce the risk of falling while the patient is in their bed include ensuring:

Bed is in a low position

Bed brakes are on

Patient can reach necessary items

Falls involving wheelchairs have been reported in descriptive studies, and interventions used to reduce this risk include:

Using safety straps or seat belts in chairs and wheelchairs

Using geriatric chairs

Using latex mesh in chairs to prevent patients slipping

Selecting suitable chairs that have arm rests and are of appropriate height for rising and sitting

Many other interventions have been used to reduce the risk of falling and include:

Using colored identification arm bands and stickers for doors and patient charts

Revising staffing procedures (1:1, direct observation, fall precautions)

Demonstrating the use of call bell to patients and ensuring it is within reach of patient

Involving family in care

Reassessing staffing needs in relation to high risk patients

Follow-up with individual caregivers