Fall Risk Interventions: The Role of Nurses in Preventing Falls

If you have been in a hospital, you might have noticed patients with color-coded wristbands or socks. These are two ways nurses and other staff can quickly see if a patient is at risk of falling.

As many as 1 million people in the U.S. fall in the hospital each year. In addition, according to the Agency for Healthcare Research and Quality (AHRQ), about 800,000 residents in nursing homes fall annually.

Falls can cause fractures, internal bleeding and other issues that require additional treatment. They can also lead to reduced quality of life, increased fear of falling, decreased ability to function and even death.

Because nurses are at the frontlines in healthcare facilities like hospitals, nursing homes and rehabilitation centers, they are key to fall-risk interventions.

If you hold a bachelor’s degree, Xavier University can help you become a nurse faster with our second-degree Accelerated Bachelor of Science in Nursing program. Our 16-month Accelerated BSN program in Ohio has three start dates each year: January, May and August. If you have some college credits, you may want to consider the BSN/BLA Pathway that will allow you to finish general education and prerequisite requirements online prior to beginning the 16 month Accelerated BSN program.

The Importance of Fall Prevention in Healthcare Settings

Preventing falls in healthcare settings is an integral part of creating a culture of safety that improves care quality and patient outcomes.

According to an article in Gerontologist, nurses likely have the most impact on reducing patient falls due to their around-the-clock presence and consistent contact with patients. This can create perceived pressure from the administration, leading to harmful consequences for nurses and their patients.

One study by Press Ganey, using data from its National Database of Nursing Quality Indicators, found that falls and associated costs were linked to registered nurse turnover rates. Units with fewer falls also had low RN turnover rates, indicating improved patient safety.

An article in The Online Journal of Issues in Nursing reported that facilities that were more successful in preventing falls had the following characteristics of a safe culture, among others:

• Support from leaders
• Engagement of frontline clinical staff
• Teamwork
• A system for data collection and management
• Rejection of the belief that “falls are inevitable”
• Adequate time for training

Ultimately, fall prevention aims to prevent falls and improve patients’ functioning and health.

Fall Risk Interventions in Nursing

In a hospital or other healthcare setting, patients can fall for several reasons, including being in an unfamiliar environment, having a severe illness, medication effects and tripping over equipment. Nursing interventions for fall prevention can help improve a patient’s chances of avoiding falls.

An article in the American Nurse Journal emphasizes three steps to preventing falls:

• Fall risk screening: Use an assessment tool to score a patient’s risk factors, such as previous fall history, gait instability, medication and more.
• Personalized care plan: Collaborate with the patient and family members to address each risk factor rather than solely the patient’s fall risk level.
• Consistent preventive intervention: The patient’s care team should consistently carry out the fall prevention plan.

Similarly, the AHRQ states that preventing falls in hospitals requires a multidisciplinary approach, meaning everyone involved in a patient’s care must participate. The agency breaks down fall prevention activities into several steps:

Universal Fall Precautions

Use universal fall precautions, which include:

• Familiarizing the patient with the environment
• Setting the call light within the patient’s reach and having them demonstrate its use
• Keeping the patient’s personal items within reach
• Placing the hospital bed low when a patient is resting but raising it when they are transferring out of bed
• Locking bed brakes
• Having the patient wear nonslip footwear
• Keeping the patient’s room uncluttered and the floor clean and dry
• Making regular rounds
• Following safe patient handling methods

Note that while patients are often in bed resting; walking and moving can help them retain their strength and mobility.

Fall Risk Assessment

In addition to following universal fall prevention protocols, the patient can be assessed for fall risks when admitted by asking the following questions.

• Does the patient have a history of falls?
• Does the patient have mobility problems or use an assistive device like a walker?
• What medications does the patient take? Some can cause sleepiness or confusion or affect balance.
• What is the patient’s mental status? Issues like dementia or delirium can put them at risk.
• Does the patient have to go to the toilet frequently?

Other risks can include being attached to equipment like an IV pole, environmental hazards or conditions that cause the patient to become lightheaded when standing.

As part of fall prevention nursing, nurses can use a tool like the Morse Fall Scale to help determine a patient’s risk of falling.

Nursing Interventions to Prevent Falls in Older Adults

Research has shown that falls are one of the most common issues contributing to disability, especially among older adults. More than 30% of people over age 65 fall each year, and 10% of those falls result in a serious injury like a hip fracture or traumatic brain injury.

Studies have shown that a comprehensive geriatric assessment can help identify older adults at risk of falling. This multidimensional process is performed by a multidisciplinary team of healthcare professionals, including nurses.

Fall Prevention Nursing Plans

Once fall risk factors are determined, the care team should create an individualized fall prevention plan for the patient. Some steps to include in fall prevention interventions are:

• Additional supervision
• Educating patients
• A medication review
• Visual cues like colored socks or wristbands
• Bed alarms or other technologies
• Mobility assistance
• Educating family members

Prevention plans should be customized because every patient has a different set of fall risk factors. Including the patient in developing a plan is essential to the plan’s success.

Nurses, physical and occupational therapists, pharmacists and other providers are essential to a patient’s care plan.

Close friends and family members can be engaged to help identify a patient’s risk factors, share any history of falls and what caused them and help ensure the prevention plan is followed.

Tools and Technologies in Fall Prevention Nursing

Technology can help prevent falls in some cases.

Alarm systems alert staff when patients try to leave their bed or a chair without help and remind patients to call for help. These systems can include pressure mats, motion detectors, cord-activated alarms and wearable devices. Studies have shown, however, that alarms can be harmful for dementia patients, according to an article published in Clinics in Geriatric Medicine.

Centralized video monitoring or virtual sitters can help observe patient activity. While a sitter is a person who physically sits in a patient’s room to keep an eye on them, a virtual sitter can monitor the patient from a distance via a live stream. If the patient starts to get up, the sitter can call a nurse to assist or remind the patient to wait for help.

Artificial intelligence (AI) can be used in combination with in-room sensors to detect the signs of a patient trying to get out of bed or a chair. Nurses can be alerted before the patient is able to do so, possibly preventing falls.

Other technologies being tested include socks with sensors and robotics.
Technology alone can’t prevent falls. It requires an alert care team, patient cooperation and a culture of safety.

Start Your Nursing Journey at Xavier

If you are interested in fall prevention nursing, Xavier University’s Accelerated BSN can leverage your previous degree, allowing you to earn your nursing degree in as few as 16 months. The fast-paced curriculum includes three components.

• Online courses on the fundamentals and theories of the profession.
• Nursing skills and simulation labs in Columbus or Cleveland focus on your applied skills development and clinical judgment.
• Clinicals at local healthcare facilities provide real-world experience in diverse areas of patient care.

Contact us to learn how you can earn your nursing degree.