From the Guidelines
Hospital fall protocols should prioritize a comprehensive approach to prevent patient falls and minimize injuries, focusing on fall risk assessment, environmental safety measures, and clear communication, as emphasized in the most recent guidelines from 2021 1. The standard protocol includes conducting a fall risk assessment upon admission using validated tools, implementing appropriate interventions based on risk level, and ensuring clear communication about fall risk status through visual indicators. Some key interventions include:
- Using alarm systems and special equipment, such as enclosure beds, to minimize fall risk, as suggested in a study from 2009 1
- Implementing environmental safety measures, such as rubber or non-slip floor surfaces, even floor surfaces, handrails, and adequate lighting, as recommended in guidelines from 2014 1
- Providing fall prevention training to patients at risk for falls, as emphasized in the 2021 guidelines from the American Heart Association/American Stroke Association 1 The most critical aspect of hospital fall protocols is to provide a formal fall prevention program during hospitalization, as recommended by the 2016 AHA/ASA guidelines, which is further supported by the 2021 guidelines 1. Post-fall procedures involve immediate patient assessment, vital signs monitoring, neurological checks, physician notification, and documentation of the incident. These protocols are critical because falls represent a significant patient safety concern, potentially resulting in serious injuries, extended hospital stays, and increased healthcare costs, particularly for elderly patients or those with mobility issues, cognitive impairments, or certain medications that affect balance and coordination. The 2021 guidelines 1 highlight the importance of evaluating patients for fall risk and introducing fall management and risk reduction interventions to improve quality of life. Overall, a comprehensive approach to hospital fall protocols, prioritizing fall risk assessment, environmental safety measures, and clear communication, is essential to minimize injuries and improve patient outcomes, as supported by the most recent and highest-quality evidence 1.
From the Research
Fall Protocol in Hospitals
- Falls are a significant problem in hospitals, with over 84% of adverse events related to falls 2
- Various fall risk assessment tools have been developed, including the Morse Fall Scale, STRATIFY, and Hendrich II Fall Risk Model 2, 3
- The STRATIFY tool has been found to have greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00) 2
- The Morse Fall Scale has also been shown to be a predictor of patient fall risk in acute care settings, with other significant predictors including male gender and diagnosis (neurologic, cardiac, general medical/surgical conditions) 4
- The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) has been found to more accurately reflect acute changeable conditions related to fall risk measurements after admission, with a higher AUC value for predicting falls than the Morse Fall Scale 5
- In older adult inpatients over 80 years of age, the Morse Fall Scale has been shown to have the highest predictive value for falls, with an area under the receiver operating characteristic curve (AUC) of 0.813 (95% CI 0.676-0.949) 6
Fall Risk Assessment Tools
- The following tools have been studied for their validity in assessing fall risk in hospitalized patients:
Implementation and Testing
- The operation of fall risk assessment tools should be tested prior to implementation, as their behavior can vary considerably depending on the population and environment 2
- Reassessment of fall risk during a patient's stay can lead to a significant reduction in the diagnostic odds ratio (DOR) of the Morse Fall Scale 2
- Further studies are needed to investigate the effect of reassessment of fall risk assessment tools and to consider the real compliance by healthcare personnel with procedures related to patient safety, particularly concerning the prevention of falls 2