Don’t Slip Up: Preventing Slips, Trips and Falls to Keep Patients and Hospital Staff Safer

Slips, trips and falls (STFs) can happen anywhere, and hospitals are no exception. Whether in a patient room or an operating room, STFs are a potentially costly and largely preventable risk to both patients and hospital staff alike.

Falls are of particular concern with patients over the age of 65, who make up the vast majority of hospitalized patients. According to the Centers for Disease Control and Prevention (CDC), falls among older adults are the leading cause of fatal and non-fatal injuries among people over 65. In 2014, 29 million older Americans experienced a fall, with around 800,000 requiring a hospital stay. There is also the risk of patients falling while they’re in the hospital. The Agency for Healthcare Research and Quality (AHRQ) estimates that between 700,000 and 1 million hospitalized patients fall each year.

When patients slip, trip or fall in the hospital, there are reimbursement implications. The Centers for Medicare and Medicaid Services (CMS) classifies death or serious injury from a fall while being cared for by a healthcare facility as a “never event,” meaning they do not reimburse additional costs related to falls. And the cost is not insignificant. According to the CDC, the average cost for a fall is more than $30,000, with total medical costs related to falls estimated at more than $50 billion. Research has also shown that falling once doubles the chances of a person experiencing another fall, so if a patient enters the hospital because of a fall, the odds of them falling while in the hospital are even higher, placing increased risk to the patient’s outcome and experience, as well as burden on the hospital staff caring for them.

Luckily, by combining a concerted effort to follow available guidelines and incorporating the right equipment and training for clinicians, it is possible to reduce the number of falls experienced by patients.

Hospitals are places where vulnerable patients come to receive the best, safest care possible. Patients enter for many reasons, and while there, everything must be done to ensure their needs and regulators’ expectations are met.

While the factors contributing to falls are unique to each patient, according to an analysis of the Joint Commission’s Sentinel Event database on falls with injury, the most common factors that contribute to STFs include:

• Inadequate assessment
• Communication failures
• Lack of adherence to protocols and safety practices
• Inadequate staff orientation, supervision, staffing levels or skill mix
• Deficiencies in the physical environment
• Lack of leadership

There is extensive research focused on quality improvement efforts aimed at reducing the number of falls in a hospital.

According to industry accreditors and research agencies, including the Joint Commission and AHRQ, best practices hospitals should follow to reduce falls and falls-related injuries include:

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• Raise awareness broadly: The responsibility for identifying and monitoring fall risks in patients does not fall squarely on nurses. Hospitals should use a multidisciplinary approach for intervention that includes clinical and non-clinical staff at every level. Form an interdisciplinary falls prevention team, and consider appointing an executive sponsor who is empowered to ensure adequate equipment and resources are available to set hospital staff up for success.
• Use tools and a tailored approach: Not all patients, including ones identified as a fall risk, have the same needs. Therefore, an individualized care plan that’s responsive to differing risk factors, needs, and preferences, should be implemented. It’s important that someone perform a comprehensive, individualized assessment for falls and injury risk on a patient. It’s also a good idea to use a standardized tool to identify fall risk factors, such as the Morse Fall Scale, and have it integrated into your hospital’s electronic health record, if possible.
• Ensure proper training: The best approach to preventing falls starts with having the right information. To that end, make sure staff have undergone training and understand the best protocol to prevent STFs, and, if using a tool like the Morse Fall Scale, ensure they’re trained on it. If possible, be sure the training and patient education is structured and comes from health professionals rather than being provided ad hoc.
• Have the right equipment: Some STFs can take place because of fluid on the floor or a generally slippery floor surface. It’s not enough to give patients advice on safe footwear. Providing them with safe footwear that has grips can help when they are up and mobile, whether on their own or with the assistance of a hospital worker, can help. Equipment can also help with continence management, including offering frequent assistance with toilet routines. Having the right equipment, such as a commode, available can encourage more mobility.
• Look at prescriptions: Another way to reduce falls is through clinical interventions, which can include medication management. As part of an assessment, review and, if medically appropriate, consider discontinuing medications associated with increased risk of falls, especially psychotropic or deliriogenic medication.
• Help patients help themselves: By providing early access to medical advice on fall prevention, mobility aids such as canes or walkers, and, if medically cleared, exercise with a physiotherapist, hospital staff can boost a patient’s confidence and strength, which can help prevent future falls.
• Conduct post-fall management: A patient falling in a hospital can provide staff a valuable learning opportunity. To learn from the incident, assemble a huddle comprised of staff at all levels to discuss what, how and why the fall happened and what steps can be taken in the future to prevent it. Encourage a culture of open and honest reporting, so staff feel empowered to come forward with information. Analyze the falls data and look for trends that can be addressed proactively.