Question

patient safety and falls in the hospital environment

Answer 1

Falls are the most commonly reported patient safety incident in the acute hospital setting. Falls can result in death or severe injury, including fractures; no fall can be regarded as entirely harmless because they are also associated with fear of further falls, delayed functional recovery and increased length of hospital stay.

The factors that contribute to patient falls in hospitals are numerous and sometimes complex, resulting in a problem that has no simple or global solution. Patients might be at a high risk of falling due to:

1) Medical conditions

2) Cognitive impairments

3) Medications

4) Other intrinsic factors.

5) Some patients might fall as a result of an unanticipated medical event, such as a seizure.

6) In other instances, patients might fall simply as a result of environmental hazards, such as a poorly placed piece of furniture, a cord, or clutter.

Below are 15 safety precautions² for fall prevention in hospitals:

1. Consider patients’ risk of falling when assigning room locations (e.g., locate high-risk patients close to or in view of the nursing station).
2. Orient new patients to the environment so they are familiar with the location and any potential obstacles. Patients who have cognitive impairments might require repeat or periodic reorientation.
3. Ensure that appropriate signage is used in the facility and that the wording is clear and readable.
4. Teach patients how to properly use, and when to use, the call system; ask them to demonstrate their understanding of how the system works. Make sure that the controls for the call system are within the patient’s reach.
5. Organize the patient’s personal items — particularly frequently used items — within the patient’s reach.
6. Install sturdy handrails in patient rooms, bathrooms, and hallways.
7. Teach and encourage patients to properly use assistive devices (e.g., walkers, wheelchairs, canes).
8. Keep hospital beds in a low position at all times, except when transferring patients from beds or providing patient care.
9. Keep hospital bed brakes locked unless the bed is being moved, and make sure wheelchair wheels are locked when patients are transferring in or out of chairs or the chairs are stationary.
10. Make sure protective equipment and supplies are readily available and fully utilized (e.g., grab bars, hip protectors, individualized wheelchair seating, alarms/sensors, and nonslip footwear in various sizes).
11. Educate staff members about safe patient handling practices, and monitor them for compliance.
12. Use night lights or supplemental lighting to help patients move safely in low-light areas and situations.
13. Keep floor surfaces clean and dry. Clean up all spills promptly, and use “wet floor” signs as appropriate.
14. Regularly assess the environment, including patient rooms and common areas, for potential fall hazards (e.g., clutter, cords, poorly designed furniture, sharp edges, carpeting hazards, etc.).
15. Implement a mechanism for reporting and reviewing potentially dangerous environmental conditions. Educate staff members about reporting procedures.

These strategies represent a sample of actions that hospital leaders, providers, and staff can take to help prevent patient falls as a result of environmental factors. Other strategies will involve consideration of patients’ physical and cognitive limitations, history and risk of falling, medications, etc.