Falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays.
Falls are the most common adverse event reported in hospitals. (National Center for Injury Prevention and
Control: Falls among Older Adults: An Overview. http://www.cdc.gov/ncipc/factsheets/adultfalls.htm)
Reviews of observational studies in acute care hospitals show that fall rates range from 1.3 to 8.9 falls/1,000
patient days and that higher rates occur in units that focus on eldercare, neurology and rehabilitation (Oliver,
2010 [C]). When this initial protocol was developed in 2008, best reported performance in fall rates was
in the range of 2.5-3.5 falls/1,000 patient days, with injury rates as low as 0.1/1000 patient days (Lancaster,
2007 [D]).
Application of interventions similar to those suggested in this protocol have achieved further reduction in
fall and injury rates. A four-year fall rate reduction of 63.9% to 1.3 falls/1,000 patient days with only two
major injuries over four years has been reported by Staten Island University Hospital (Weinberg, 2011 [C]).
The work group members shared their local falls rate data, as well as their most effective local interventions
and finds that fall rates under 2.0 falls/100 patient days are achievable.
The purpose of fall prevention efforts is actually injury prevention and safety. There is greater focus on
falls injury prevention as public reporting of fractures, serious injury and death has become available. The
panel is aware of published and local reports of injury free intervals over one year in duration in acute care
hospitals (Weinberg, 2011 [C]).
The current Minnesota Adverse Health Care Events Reporting Law requires the reporting of falls for those
associated with a serious disability in addition to those associated with a death. In contrast, in Minnesota,
the reporting of fall rates to the Minnesota Hospital Association is on a voluntary basis, with the information
available to other members. Lowering fall rates is associated with a decrease in the injury rate, and voluntary
reporting leads to awareness of better performing hospitals in terms of what fall rates are achievable; it
may help drive improved performance (Minnesota Department of Health, 2012 [D]; Lancaster, 2007 [D];
Serious Reportable in Massachusetts Acute Care Hospitals [NA]).
A leading goal of the patient safety movement is the reduction and eventual elimination of falls that result
in injury. Therefore, falls prevention programs should focus on factors associated with increased injury
risk. The epidemiology of falls with injury may vary by hospital type, such as academic or non-academic,
or physical plant factors. A retrospective cohort study of nine midwestern hospitals stated that injury was
associated with older age, unassisted falls, bathroom falls and in patient care areas outside of the patient's
room (Krauss, 2007 [C]).
Findings such as these influence the rationale for commonly used interventions. These include close observation,
visual identifiers and communication of falls risk to all departments and disciplines.
In spite of extensive research on falls risk factors and the development of a number of falls risk instruments,
protocols are applied inconsistently, and risk factor directed interventions are far from standardized.
This was evident in the key findings from the 2012 Minnesota Adverse Health Care Event on reportable
falls with injury.
Many reportable falls were related to problems with the fall risk assessment process, including inconsistent
application of interventions to the patient's fall risk, miscommunication of fall risk, or failure to properly
assign patients to high risk.
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Prevention of Falls (Acute Care) Protocol
Third Edition/April 2012