Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cb9f654ff-lqqdg Total loading time: 0 Render date: 2025-08-07T19:54:38.326Z Has data issue: false hasContentIssue false

26 - Fall Prevention in Hospitals

from Part II - Strategies for Prevention

Published online by Cambridge University Press:  04 November 2021

By
Anne-Marie Hill
Edited by
Stephen R. Lord ,
Catherine Sherrington  and
Vasi Naganathan
Stephen R. Lord
Affiliation:
Neuroscience Research Australia, Sydney
Catherine Sherrington
Affiliation:
Sydney Medical School
Vasi Naganathan
Affiliation:
Concord Hospital
Get access

Summary

Falls are one of the most frequent adverse events that occur in hospitals [1, 2]. Fall rates range from 3.4 to 11 falls per 1000 bed days in acute and rehabilitation wards [3–6]. These rates translate to significant numbers of patients falling during a hospital stay; for example, in England there were over 250,000 falls in hospitals 2015/2016 [1], and it is estimated that nearly one million patients fall in US hospitals each year [2]. For these patients, a hospital admission intended to improve health may result in serious injuries and even death.

Information

Type
Chapter
Information
Falls in Older People
Risk Factors, Strategies for Prevention and Implications for Practice
 , pp. 396 - 409
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

NHS Improvement. The incidence and costs of inpatient falls in hospitals. 2017. https://improvement.nhs.uk/resources/incidence-and-costs-inpatient-falls-hospitals/ (accessed July 2019).Google Scholar
Ganz, DA, Huang, C, Saliba, D et al. Preventing falls in hospitals. A Toolkit for improving quality of care. U.S. Department of Health and Human Services. Agency for Health Care Research and Quality (AHRQ). 2013. www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html (accessed April 2021).Google Scholar
Bouldin, EL, Andresen, EM, Dunton, NE et al. Falls among adult patients hospitalized in the United States: prevalence and trends. J Patient Saf. 2013;9:13–17.Google Scholar
Hill, A-M, McPhail, SM, Waldron, N et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet. 2015;385:2592–9.CrossRefGoogle ScholarPubMed
Haines, TP, Bennell, KL, Osborne, RH et al. Effectiveness of targeted fall prevention programme in subacute hospital setting: randomised controlled trial. Br Med J. 2004;328:676.Google Scholar
Schwendimann, R, Buhler, H, De Geest, S et al. Characteristics of hospital inpatient falls across clinical departments. Gerontology. 2008;54:342–8.Google Scholar
Haines, TP, Hill, A-M, Hill, KD et al. Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Arch Intern Med. 2011;171:516–24.Google Scholar
Healey, F, Scobie, S, Oliver, D et al. Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care. 2008;17:424–30.CrossRefGoogle ScholarPubMed
Hignett, S, Sands, G, Griffiths, P. In-patient falls: what can we learn from incident reports? Age Ageing. 2013;42:527–31.CrossRefGoogle ScholarPubMed
Staggs, VS, Mion, LC, Shorr, RI. Assisted and unassisted falls: different events, different outcomes, different implications for quality of hospital care. Jt Comm J Qual Patient Saf. 2014;40:358–64.Google Scholar
Turner, N, Jones, D, Dawson, P et al. The perceptions and rehabilitation experiences of older people after falling in the hospital. Rehabil Nurs. 2019;44:141–50.CrossRefGoogle ScholarPubMed
Hill, A-M, Jacques, A, Chandler, AM et al. In-hospital sequelae of injurious falls in 24 medical/surgical units in four hospitals in the United States. Jt Comm J Qual Patient Saf. 2019;45:91–7.Google Scholar
Morello, RT, Barker, AL, Watts, JJ et al. The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust. 2015;203:367.CrossRefGoogle Scholar
Deandrea, S, Bravi, F, Turati, F et al. Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr. 2013;56:407–15.Google Scholar
O’Neil, CA, Krauss, MJ, Bettale, J et al. Medications and patient characteristics associated with falling in the hospital. J Patient Saf. 2018;14:27–33.Google Scholar
Oliver, D, Daly, F, Martin, FC et al. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing. 2004;33:122–30.CrossRefGoogle ScholarPubMed
Inouye, SK, Westendorp, RG, Saczynski, JS. Delirium in elderly people. Lancet 2014;383:911–22.Google Scholar
Hshieh, TT, Yue, J, Oh, E et al. Effectiveness of multicomponent non-pharmacological delirium interventions. JAMA Intern Med. 2015;175:512–20.Google Scholar
Wong, JS, Brooks, D, Mansfield, A. Do falls experienced during inpatient stroke rehabilitation affect length of stay, functional status, and discharge destination? Arch Phys Med Rehabil. 2016;97:561–6.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE). Falls in Older People: Assessing Risk and Prevention. Clinical Guideline [CG161]. 2013. www.nice.org.uk/guidance/cg161 (accessed April 2021).Google Scholar
Oliver, D, Healey, F, Haines, TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med. 2010;26:645–92.CrossRefGoogle ScholarPubMed
de Jong, LD, Francis-Coad, J, Waldron, N et al. Does free-text information in falls incident reports assist to explain how and why the falls occurred in a hospital setting? J Patient Saf. 2018;[e-pub ahead of print]. doi:10.1097/pts.0000000000000533.Google Scholar
Hill, A-M, Hoffmann, T, Hill, K et al. Measuring falls events in acute hospitals: a comparison of three reporting methods to identify missing data in the hospital reporting system. J Am Geriatr Soc. 2010;58:1347–52.Google Scholar
Rapp, K, Ravindren, J, Becker, C et al. Fall risk as a function of time after admission to sub-acute geriatric hospital units. BMC Geriatr. 2016;16:173.Google Scholar
Corsinovi, L, Bo, M, Ricauda Aimonino, N et al. Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. Arch Gerontol Geriatr. 2009;49:142–5.Google Scholar
Coker, E, Oliver, D. Evaluation of the STRATIFY falls prediction tool on a geriatric unit. Outcomes Manag. 2003;7:8–14;quiz 15–16.Google Scholar
Morse, JM, Black, C, Oberle, K et al. A prospective study to identify the fall-prone patient. Soc Sci Med. 1989;28:81–6.Google Scholar
Healey, F, Haines, TP. A pragmatic study of the predictive values of the Morse falls score. Age Ageing. 2013;42:462–8.CrossRefGoogle ScholarPubMed
Oliver, D, Papaioannou, A, Giangregorio, L et al. A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: how well does it work? Age Ageing. 2008;37:621–7.Google Scholar
Mion, LC, Chandler, AM, Waters, TM et al. Is it possible to identify risks for injurious falls in hospitalized patients? Jt Comm J Qual Patient Saf. 2012;38:408–13.Google Scholar
Australian Commission on Safety and Quality in Healthcare. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Australian Hospitals. 2009. www.safetyandquality.gov.au/publications-and-resources/resource-library/preventing-falls-and-harm-falls-older-people-best-practice-guidelines-australian-hospitals (accessed April 2021).Google Scholar
Haines, TP, McPhail, SM. Threat appraisal for harm from falls: insights for development of education-based intervention. Open Longev Sci. 2011;5:9–15.Google Scholar
Lee, DC, McDermott, F, Hoffmann, T et al. ‘They will tell me if there is a problem’: limited discussion between health professionals, older adults and their caregivers on fall prevention during and after hospitalization. Health Educ Res. 2013;28:1051–66.Google Scholar
Twibell, RS, Siela, D, Sproat, T et al. Perceptions related to falls and fall prevention among hospitalized adults. Am J Crit Care. 2015;24:e78–85.Google Scholar
Haines, TP, Lee, DC, O’Connell, B et al. Why do hospitalized older adults take risks that may lead to falls? Health Expect. 2012;18:233–49.Google Scholar
Hill, A-M, Francis-Coad, J, Haines, TP et al. ‘My independent streak may get in the way’: how older adults respond to fall prevention education in hospital. BMJ Open. 2016;6:e012363.CrossRefGoogle Scholar
Hill, A-M, McPhail, SM, Francis-Coad, J et al. Educators’ perspectives about how older hospital patients can engage in a fall prevention education programme: a qualitative process evaluation. BMJ Open. 2015;5:e009780.CrossRefGoogle Scholar
Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service (NSQHS) Standards. www.safetyandquality.gov.au/standards/nsqhs-standards (accessed April 2021).Google Scholar
National Health Service Improvement. Improvement Hub: Patient Safety. https://improvement.nhs.uk/improvement-hub/patient-safety/ (accessed April 2021).Google Scholar
Cameron, ID, Dyer, SM, Panagoda, CE et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018;2018:CD005465.Google Scholar
Avanecean, D, Calliste, D, Contreras, T et al. Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. JBI Database System Rev Implement Rep. 2017;15:3006–48.Google Scholar
Miake-Lye, IM, Hempel, S, Ganz, DA et al. Inpatient fall prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:390–6.Google Scholar
Hempel, S, Newberry, S, Wang, Z et al. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. J Am Geriatr Soc. 2013;61:483–94.CrossRefGoogle ScholarPubMed
Guyatt, G, Oxman, AD, Akl, EA et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–94.CrossRefGoogle ScholarPubMed
Shorr, RI, Mion, LC, Chandler, AM et al. Improving the capture of fall events in hospitals: combining a service for evaluating inpatient falls with an incident report system. J Am Geriatr Soc. 2008;56:701–4.Google Scholar
LeLaurin, JH, Shorr, RI. Preventing falls in hospitalized patients: state of the science. Clin Geriatr Med. 2019;35:273–83.Google Scholar
Oliver, D. Do bed and chair sensors really stop falls in hospital? Br Med J. 2018;360:k433.Google Scholar
Shorr, RI, Chandler, AM, Mion, LC et al. Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial. Ann Intern Med. 2012;157:692–9.Google Scholar
Sahota, O, Drummond, A, Kendrick, D et al. REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial. Age Ageing. 2014;43:247–53.Google Scholar
Haines, TP, Bell, RA, Varghese, PN. Pragmatic, cluster randomized trial of a policy to introduce low-low beds to hospital wards for the prevention of falls and fall injuries. J Am Geriatr Soc. 2010;58:435–41.Google Scholar
Barker, AL, Morello, RT, Wolfe, R et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. Br Med J. 2016;352:h6781.Google Scholar
Hartung, B, Lalonde, M. The use of non-slip socks to prevent falls among hospitalized older adults: a literature review. Geriatr Nurs. 2017;38:412–16.CrossRefGoogle ScholarPubMed
Chari, S, Haines, T, Varghese, P et al. Are non-slip socks really ‘non-slip’? An analysis of slip resistance. BMC Geriatr. 2009;9:39.Google Scholar
Lang, CE. Do sitters prevent falls? A review of the literature. J Gerontol Nurs. 2014;40:24–33;quiz 34–5.Google Scholar
de Jong, LD, Weselman, T, Kitchen, S, Hill, A-M. Exploring hospital patient sitters’ fall prevention task readiness: a cross-sectional survey. J Eval Clin Pract. 2020;26:42–9.Google Scholar
Wood, VJ, Vindrola-Padros, C, Swart, N et al. One to one specialling and sitters in acute care hospitals: a scoping review. Int J Nurs Stud. 2018;84:61–77.Google Scholar
Royal College of Physicians. National Audit of Inpatient Falls: Audit Report 2017. www.rcplondon.ac.uk/projects/outputs/naif-audit-report-2017 (accessed July 2019).Google Scholar
Carroll, DL, Dykes, PC, Hurley, AC. Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention. Appl Nurs Res. 2010;23:238–41.Google Scholar
Hill, A-M, Waldron, N, Francis-Coad, J et al. ‘It promoted a positive culture around fall prevention’. Staff response to a patient education programme: a qualitative evaluation. BMJ Open. 2016;6:e013414.CrossRefGoogle Scholar
Dykes, C, Carroll, DL, Hurley, A et al. Fall prevention in acute care hospitals. J Am Med Assoc. 2010;304:1912–18.Google Scholar
Royal College of Psychiatrists’ Centre for Quality Improvement. Healthcare Quality Improvement Partnership (HQIP). National Audit of Dementia. 2017. www.hqip.org.uk/a-z-of-nca/dementia-care-in-general-hospitals/ (accessed April 2021).Google Scholar
Inouye, SK, Bogardus, ST Jr., Baker, DI et al. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. J Am Geriatr Soc. 2000;48:1697–706.Google Scholar
Diaz-Gutierrez, MJ, Martinez-Cengotitabengoa, M, Saez de Adana, E et al. Relationship between the use of benzodiazepines and falls in older adults: a systematic review. Maturitas. 2017;101:17–22.Google Scholar
Peterson, JF, Kuperman, GJ, Shek, C et al. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med. 2005;165:802–7.Google Scholar
National Institute for Health and Care Excellence (NICE). Falls in Older People. Quality Standard [QS86]. 2015. www.nice.org.uk/guidance/qs86 (accessed April 2021).Google Scholar
Francis-Coad, J, Etherton-Beer, C, Bulsara, C et al. Using a community of practice to evaluate fall prevention activity in a residential aged care organisation: a clinical audit. Aust Health Rev. 2016;41:13–18.Google Scholar
Mardon, RE, Khanna, K, Sorra, J et al. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010;6:226–32.Google Scholar

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×