Falls Prevention: Injurious Fall Rates

Topic: Nursing
Words: 2313 Pages: 8

The issue in question is the falls prevention in patients who are staying at a medical facility. This quality improvement (Q.I.) project should ensure that the rate of falls in an inpatient care facility is reduced. A risk factor is anything that makes it more likely for older adults to fall. As the probability of falling increases with the number of risk factors that are present, falls frequently come from a combination of risk factors (Innab, 2022). As a person matures, there are more risk variables to consider. There are several ways to categorize risk variables. Classifying them as personal or environmental is one of the most used techniques (Innab, 2022). Individual traits, including age, gender, skill, and health issues, are examples of personal risk variables. Environmental risk factors are dangers that may be encountered at home, in the neighborhood, and in public spaces. Examples include uneven floors and a lack of handrails or grab bars. This Q.I. aims to review the literature on the topic of fall prevention and present a plan for addressing falls in hospital settings.

Although there is enough literature that focuses on fall prevention strategies, there are substantial barriers that obstruct healthcare providers from successfully reducing the number of fall instances. It is necessary to boost older individuals’ access to and compliance with fall prevention measures. Falls have been deemed a top concern for hospitalized patients and can lead to a more extended stay in the hospital as well as higher healthcare expenses (Innab, 2022). The use of medication evaluation and adjustment, staff education, inter-professional teamwork, and post-fall huddles were some of the techniques that nurses found to be successful in lowering the occurrence of falls. In other studies, researchers concluded that healthcare personnel should utilize fall risk ratings as recommendations to decrease falls in acute care settings rather than generic fall risk-reduction techniques. Possible ethical and political factors that contribute to fall prevention are the current procedures for the management of patients.

Review of Literature

The statistics on the number of falls in healthcare settings suggest that this is a significant issue affecting many patients. Inlab (2022) focuses on studying the literature findings and protocols on falls. In clinical settings, falls pose a considerable risk to patient safety and can result in severe consequences and death. The World Health Organization (WHO) estimates that 646,000 people die as a result of falls each year, making them the second most significant cause of death globally (Inlab, 2022). Hence, falls result not only in injuries or complications but can also result in death. The WHO also predicts that 37.3 million falls are severe enough to necessitate medical attention (Inlab, 2022). Falls have been highlighted as a critical concern among hospitalized patients, and because they can result in a more extended stay in the hospital as well as higher healthcare expenses, there is a substantial body of literature on fall risk factors and prevention. Inpatient fall rates range from 25% to 45 percent, according to researchers (Inlab, 2022). However, healthcare practitioners have a significant problem in reducing inpatient falls in acute care settings. Preventable risk factors for falls should be thoroughly examined, according to researchers, in order to develop suitable treatments and lessen the burden of falls.

Since there are so many elements that lead to falls, risk factors are divided into intrinsic and extrinsic categories. Intrinsic risk factors include those that are specific to the patient, such as age, history of falls, poor balance and walking skills, lower extremity weakness, Parkinson’s disease history, dizziness, and impaired eyesight (Inlab, 2022). A lot of studies have discovered that patient age, physical weakness, and cognitive impairment are all factors. Environmental characteristics that impact patient safety are known as extrinsic factors. The most usually reported irrelevant factor in falls is the use of drugs such as antidepressants, antipsychotics, and sedatives. Extrinsic variables such as slick or uneven terrain, insufficient illumination, or high-risk activities have been observed in various nations.

Some researchers focus on implementing programs that target fall prevention and can be generalized to different healthcare settings. This research by Fernandes et al. (2021) intends to investigate perceived obstacles to fall prevention among older persons. The method adopted was a qualitative descriptive one, and 18 older adults who attended a daycare program run by a private institution for social solidarity in the Portuguese cities of Lisbon and Tagus Valley participated in semi-structured interviews. In September 2019, the hiring process began, and the interviews were verbatim recorded, transcribed, and thematically analyzed using the constant comparison approach (Fernandes et al., 2021). The healthcare system gaps, social and economic factors, health conditions, psychological capacity, and lack of information to dispel fall-related myths and misunderstandings are obstacles to involvement in a fall prevention approach. Participation in a fall prevention approach is hampered by a variety of factors (Fernandes et al., 2021). To enhance older individuals’ involvement in fall prevention measures, it is vital to remove or lessen the impact of these impediments.

The group of older persons who are most at risk for falls also has the highest rate of fall-related injuries and fatalities. According to estimates by Fernandes et al. (2021), more than 640,000 individuals die each year as a result of falls. Among older persons, falls are the second most common cause of fatal and non-fatal injuries. From mild damage to serious injuries requiring hospitalization, fall-related injuries can occur. Broken bones and soft tissue injuries are among the most frequent serious wounds.

Teaching older persons fall prevention techniques presents several difficulties for hospital nurses. The objective of this research was to give hospital nurses evidence-based training to encourage patient participation in fall prevention strategies. Acute care nurses were given training in “Adapted” Motivational Interviewing (MI) for fall prevention (AMIFP) as part of a Veterans Affairs-Nursing Academic Partnership (VANAP) effort (Kiyoshi-Teo & Northrup-Snyder, 2022). At a U.S. acute care hospital, 61 nurses completed the pre-and post-surveys (Kiyoshi-Teo & Northrup-Snyder, 2022). Nurses claimed to have more understanding of patient participation in relation to fall prevention following the single AMIFP course. Additionally, following training, participants felt more confident employing some MI abilities to prevent falls. The knowledge and attitudes of hospital nurses to involve patients in fall prevention education can be improved even with a quick AMIFP program.

Hospital fall prevention strategies must include patient education as an essential risk prevention factor. For patients and nurses alike, fall prevention education may be challenging. For instance, older persons frequently express little interest in learning about fall prevention since many believe the suggestions are not relevant to them personally (Kiyoshi-Teo & Northrup-Snyder, 2022). Some senior citizens may protest being labeled as having a high fall risk because they worry about seeming reliant or incompetent. Additionally, patients frequently take risks in hospital settings that might result in falls, such as using the toilet or bed without assistance. Nurses often believe that patient risk behaviors are unaffected by fall prevention education or feel negative about the subject (Kiyoshi-Teo & Northrup-Snyder, 2022). For fall prevention education to be effective in the hospital context, the biases of patients and nurses must be taken into account.

Nurses have to respond to the instances of patient falls, and this response time has an effect on the outcomes of these incidents. Another article by Tzeng et al. (2012) based on fall prevention focuses on the response time of the staff to fall cases. Programs to reduce falls among hospitalized patients have had mixed results, and it is still unclear how well they affect the number of falls overall and injuries caused by falls. The unique role that calls light response time plays in predicting both overall fall rates and harmful fall rates in inpatient acute care settings was studied in an exploratory multi-hospital study. Donabedian’s framework of the structure, method, and healthcare results served as the foundation for the conceptual model (Tzeng et al., 2012). The hospital, unit type, total nursing hours per patient day, and the proportion of total nursing HPPDs provided by registered nurses. Thus, the proportion of patients 65 and older, the average case mix index, the proportion of patients with altered mental status, the proportion of patients with hearing problems, and the call light use rate per patient day were the covariates were examined in this study.

Archive data can be used to study fall prevention and provide authors with insights into prevention practices. The unit of analysis was the patient care unit-month, which was defined as data summed by month for each patient care unit. Multiple regression analyses using a hierarchy were conducted (Tzeng et al., 2012). Lower overall fall and injurious fall rates were linked to call light response times faster. Lower overall fall and injury fall rates were seen in units with increased call light use rates. Moreover, lower overall fall and injurious fall rates were correlated with a larger percentage of productive nursing hours delivered by registered nurses. After adjusting for variables, a quicker call light response time seems to be associated with decreased fall total and injury rates (Tzeng et al., 2012). The goal of reducing staff reaction times to call lights should be taken into consideration by the hospital and nursing executives when developing fall and harmful fall prevention programs. Regularly tracking call light response time is advised and may be included in evidence-based practice recommendations for preventing falls.

People of all ages can be injured or killed by falls, but as people age, their risk of falling significantly increases. Although there is no evidence to promote short-stay hospital-based fall prevention techniques to lower patient falls, hospitalization raises the risk even further. From January 1, 2009, to June 30, 2009, Dykes et al. (2010) performed cluster-randomized research comparing the patient fall rates in 4 metropolitan U.S. hospitals in units that received either the standard treatment or the intervention, precisely four units and 5160 patients (Dykes et al., 2010). FPTK software incorporated current workflow and communication practices into the HIT application. The FPTK software customized fall prevention treatments to meet individuals’ unique factors of fall risk based on a reliable fall risk assessment scale provided by a nurse (Dykes et al., 2010). Key stakeholders were informed of patient-specific warnings through the bed posters, patient education materials, and care plans that were all developed by the FPTK. The number of patients who fell during the 6-month intervention period varied across the control and intervention units. Site-adjusted fall rates in control units were substantially higher than in intervention units. In general, patients 65 years of age or older were shown to benefit from the FPTK in particular. Fall-related injuries showed no discernible change.

Proposed Plan

Based on the literature review, this Q.I. initiative can help address the frequent patient falls at a healthcare facility. Patient education is one of the main factors that can help reduce the number of falls (Tzeng et al., 2012). Moreover, ongoing assessments are a necessary procedure to ensure that patients at high risk of falls are recognized and monitored by the nursing staff. All hospitalized patients are at risk for falls because they are unwell, but certain patients are more at risk than others. To identify a patient’s unique risk factors and include treatments into their care plan to lower their risk of falling, assessment is a continuous process. The Morse Fall Scale and the Hendrich II Fall Risk Model are two commonly used fall assessment instruments used to identify people at high risk for falls (Dykes et al., 2010). Thus, this plan involves implementing patient monitoring strategies and patient education as the primary factors of fall prevention.

The interprofessional team, in this case, plays an important role because the enhancement of the quality of the provided care can only be achieved if the professionals collaborate. Interprofessional cooperation happens when two or more professions work together to accomplish shared objectives and is frequently utilized as a method of resolving a wide range of challenges (Kaap-Fröhlich, 2022). The advantages of cooperation enable members to serve greater populations, accomplish more jointly than they could individually, and advance both personally and organizationally.

Any organizational change leader faces resistance if implemented incorrectly; hence, there is a need to ensure that the leader of the change initiative understands the basis of a change management theory. For example, Kurt Lewin developed a three-step model that can be used to successfully implement quality improvement projects in healthcare facilities (Burnes, 2020). Issues can be resolved by ensuring that the interprofessional team communicates regularly and that any issues or difficulties are addressed. A plan-do-change-act (PDCA) approach can be applied in this case to review the change process and implement changes that can help ensure that the goal of the intervention, which is the reduction of the number of falls, can be achieved (Yoder-Wise, 2018). With the use of Lewin’s model and PDCA, the leader of this initiative can be successfully implemented. Implications for professional practice from this change initiative are the improvement of the quality of care and quality of life for the patients. Mainly, patient falls are a significant cause of injuries that, in many cases, will lead to the patients requiring rehabilitation or recovery from injuries (Tzeng et al., 2012). Hence, by addressing the causes of falls, the nursing professionals will be able to affect the overall well-being of individuals.

In conclusion, this paper has found that falls are a major issue in the existing healthcare system. In the future, there is a need to address the instances of falls in hospitals by addressing the main causes and creating protocols that nurses must follow to prevent these injuries. According to the WHO, falls are thought to be the cause of 646,000 fatalities annually. Moreover, inpatient fall rates might range from 25% to 45%, indicating that this is a significant issue. Every year, one in three older adults falls. Falls are the second most frequent cause of fatal and non-fatal injuries among older people.


Burnes, B. (2020). The origins of Lewin’s Three-Step Model of Change. The Journal of Applied Behavioral Science, 56(1), 32–59.

Dykes, P., Carroll, D., Hurley, A., Lipsitz, S., Benoit, A., & Chang, F. et al. (2010). Fall prevention in acute care hospitals. JAMA, 304(17), 1912.

Fernandes, J., Fernandes, S., Almeida, A., Vareta, D., & Miller, C. (2021). Older adults’ perceived barriers to participation in a falls prevention strategy. Journal of Personalized Medicine, 11(6), 450.

Innab, A. M. (2022). Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia. Nursing Open, 9, 1362– 1369.

Kaap-Fröhlich, S., Ulrich, G., Wershofen, B., Ahles, J., Behrend, R., & Handgraaf, M. (2022). Position paper of the GMA Committee Interprofessional Education in the Health Professions – current status and outlook. GMS Journal For Medical Education, 39(2), 10.

Kiyoshi-Teo, H., & Northrup-Snyder, K. (2022). “Adapted” motivational interviewing to engage hospital nurses in fall prevention education. OJIN: The Online Journal of Issues in Nursing, 27(2), 10-15.

Tzeng, H., Titler, M., Ronis, D., & Yin, C. (2012). The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four U.S. hospitals using archived hospital data. BMC Health Services Research, 12(1), 15-20.

Yoder-Wise, P. (2018). Leading and managing in nursing (7th ed.). Mosby

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