Fall Prevention

Synthesis Project
Project Group 1: Katherine Koch, Rachel Lotz, Russell Santos, Cynthia Szalma, Desiree Ward

PICO Question
On hospital acute care units,
what is the effect of
actively practicing fall prevention measures
in comparison to
before these measures were activated
in decreasing the amount of falls that occur?

Literature Review: Article 1

Bennet, P.,Ockerby,C., Stinson, J.,Willcocks ,K., Chalmers, C. (2014). Measuring hospital falls prevention safety climate.
Contemporary Nurse 47(1-2) :27-35

Summary: Falls are the most frequent adverse events that occur in the hospital. Falls during
admission can lead to increased complications, increased mortality, additional diagnosis, and
increased length of stay. Although fall prevention is a major priority in an acute setting, there is a
limited amount of tools available to measure the employees perceptions of the safety climate in
relation to fall prevention. This study allows health care workers to examine the safety climate and
determine suggestions or areas of improvement to prevent falls.
Results: This study allowed the researchers to compare the staffs perceptions of the safety climate
in general vs the safety climate with emphasis on falls prevention. This study also provided feedback
from staff on how to prevent falls in acute care units

Literature Review: Article 1

Bennet, P.,Ockerby,C., Stinson, J.,Willcocks ,K., Chalmers, C. (2014). Measuring hospital falls prevention safety climate.
Contemporary Nurse 47(1-2) :27-35

Purpose of this Study

1) Obtain baseline information from the health care team on their perceptions of the safety
climate regarding fall prevention.
2) Compare responses with four original questions which broadly asked questions about patient
safety and four questions specifically targeting fall prevention.
3) Identify strengths and areas for improvement in patient safety.

Literature Review: Article 1

Bennet, P.,Ockerby,C., Stinson, J.,Willcocks ,K., Chalmers, C. (2014). Measuring hospital falls prevention safety climate.
Contemporary Nurse 47(1-2) :27-35

Strengths
Instead of just using a standardized questionnaire to determine the health care perception on falls
prevention, the study additionally utilized open ended questions. These were then used to determine
a more realistic outlook on employees views on present strategies and personal recommendations.
This adds to the validity of the study and makes it more realistic.
Weaknesses
In this particular study, there could have been more discussion on contributing factors that cause
patients to fall. Factors related to medication, mental state of mind, specific disease processes, and
other distinguishing factors are important in discussing measurement of safety climate and should be
included in fall prevention.

Literature Review: Article 2

Bechdel, B., Bowman, C., & Haley, C. (2014). Prevention of falls: Applying AACNs healthy work environment standards to a fall campaign.
Critical Care Nurse, 34(5), 75-79. doi:10.4037/ccn2014987

Summary: This study enacted a fall campaign based on a combination of recommendations from the Institute
of Clinical Systems Improvement and beneficial work environment standards of the American Association of
Critical-Care Nurses. These measures included fall prevention discussion in daily staff huddles, a new fall
team, a bright yellow unit board to document falls, brightly colored universal signs outside fall risk rooms,
computer reports run to detect patients most at risk for falls based on assessments, a unit layout graph to
determine those most at risk (those who should be closest to the nursing station), appropriate staffing, positive
reinforcement for the number of days passed without a fall, and open communication. Risk factors that
contribute to an increased chance of falls were identified as patients with comorbidities or alcohol withdrawal,
inadequate staffing or experience, and a lack of a fall team.
Results:This study produced success with 148 days straight without a fall and an overall average of falls
below the national average. Decreased falls means improved health for the patients and less cost for the
hospital.

Literature Review: Article 2

Bechdel, B., Bowman, C., & Haley, C. (2014). Prevention of falls: Applying AACNs healthy work environment standards to a fall campaign.
Critical Care Nurse, 34(5), 75-79. doi:10.4037/ccn2014987

Strengths
This study was conducted on a 25-bed adult step-down unit in an acute care facility. This can apply to
many other floors such as telemetry, medical-surgical, intensive care, and more. The study made
good use of resources and organization, and the recommendations (listed under the summary on the
previous slide) could be utilized in other facilities to prevent falls. The strength of this fall campaign is
illustrated in the successful decrease of falls overall.
Weaknesses
There are many units that are larger than 25 beds; thus, further studies conducted on larger units
would be helpful. This study has no mention of bed alarms and I feel that these are very helpful in
preventing falls. There is always room for improvement and for further research.

Literature Review: Article 3

Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The real world journey of implementing fall prevention best
practices in three acute care hospitals: A case study. Worldviews On Evidence-Based Nursing, 10(2), 95-103.
doi:10.1111/j.1741-6787.2012.00258.x

Summary
Falls are the second leading cause of unintentional injury worldwide, and can potentially lead to more
harm and longer hospital stays. Implementation is essential in carrying out best practices in order to
reduce hospital fall rates.This study used a qualitative case study method with 95 nurses (floor RNs
and leadership) in 3 acute care hospitals. In Canada, 1 in 1263 in hospital falls among seniors
resulted in a fractured hip. 30% of falls results in injury and most of the patients involved suffer from
fear of falling again, pain, impaired function loss, and loss of confidence and well as anxiety. After
finding these alarming statistics, the researchers goal was to find a way for hospital nurses to guide
and support the successful implementation on fall prevention strategies
All three hospitals recommended a risk assessment on admission and following a fall, and
multifactorial interventions by nurses

Literature Review: Article 3

Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The real world journey of implementing fall prevention best
practices in three acute care hospitals: A case study. Worldviews On Evidence-Based Nursing, 10(2), 95-103.
doi:10.1111/j.1741-6787.2012.00258.x

Results: The fall prevention research performed ended up becoming a continuous quality
improvement process. They found there was no true endpoint or answer to fall prevention. Through
this process, they found fall prevention was a spider-web, with fall prevention being the center, and
areas of change were all over the place with different areas of implementation, holding everything
together. They came up with four implications as a guide to fall prevention implementation:
1.) Include staff in the planning and design of the fall prevention program to ensure the recognition of
complexity and reality
2.) Keep the fall prevention simple
3.) Fall prevention will require resources, time, and support
4.) Fall prevention is a continuous quality improvement at all levels.

Literature Review: Article 3

Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The real world journey of implementing fall prevention best
practices in three acute care hospitals: A case study. Worldviews On Evidence-Based Nursing, 10(2), 95-103.
doi:10.1111/j.1741-6787.2012.00258.x

Strengths

They admitted that tensions may arise from staff regarding the implementation of the falls best practice, and gave
recommendations on how to overcome.

The principal investigators were leaders at different hospital sites, so the nurses being interviewed could be truthful and
confidentiality was ensured.

Admitted different variables such as patients will still try to get up if they feel they are capable, and family members will still
try to help regardless of risk; here they touched on the fine line between autonomy and beneficence

There were multiple sources of data, they also received research ethics board approval.

Weaknesses

Lack of direct data from patients

It only focused on nurses being the ones who implemented fall prevention as opposed to ancillary nursing staff.

Healthcare environment is constantly changing; new guidelines are constantly introduced i.e. restraints

There was no real conclusion or end to the study.

Literature Review: Article 4

Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review. MEDSURG Nursing, 24(1), 51-55

Summary
This was a research article that summarized fourteen articles. These articles utilized hourly rounding
in acute care facilities to see if it reduced inpatient falls. The articles goal was to analyze the articles
and see if there is sufficient evidence of hourly rounding affecting the rate of inpatient falls. The
fourteen studies all involved hourly rounding but it varied in how the rounds were done. Hourly
rounding also positively affected other aspects, such as patient satisfaction and decreased the use of
call lights.
Results
All the studies showed that hourly rounding affected patient falls. No matter what method of hourly
rounding was used, whether scripted or not, it dramatically decreased patient fall rates in each study.

Literature Review: Article 4

Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review. MEDSURG Nursing, 24(1), 51-55

Strengths
This study used many articles as sources. These articles showed evidence that hourly rounding did
impact patient falls in all of the studies. The articles used were relevant, all written between 20092014.
Weaknesses
The article did not show a consistent method of hourly rounding. Its sample size was random and not
standardized. Implementation in the articles showed less than one year, and long term effects were
not addressed.

Literature Review: Article 5

Urquhart Wilbert, W. (2013). The Effectiveness of a Fall Prevention/Management Program In Reducing Patient Falls: A Retrospective Study.
JOCEPS: The Journal Of Chi Eta Phi Sorority, 57(1), 24-27

Summary
This is a retrospective study aimed at reducing patient falls by evaluating the effectiveness of utilizing a fall prevention program.
Over a 14 month period the medical records of 140 patients at a rural VA hospital who had previously fell or were at high risk for
falls were reviewed. 70 falls were reported and analyzed.

Results
Of the 70 falls that occurred, most happend inside the patients room. The 4 biggest factors were advanced age, psychiatric
diagnosis, decreased mobility, and certain medications especially psychotropics. It was determined that 91% of these patients
were assessed for and placed on the hospitals fall prevention program and every patient is screened on admission. The fall
prevention plan used visual reminders such as falling stars on the door/wristband for patients at high risk, keeping the call bell in
reach, low bed height, nonskid socks, hourly checks, bed/chair alarms and universal assessment to reduce the risk of falls. This
VAs data from the study demonstrates evidence that the fall prevention interventions have been effective since there is a
downward trend of 0.6 falls per 1000 patient days since implementing a fall prevention program.

Literature Review: Article 5

Urquhart Wilbert, W. (2013). The Effectiveness of a Fall Prevention/Management Program In Reducing Patient Falls: A Retrospective Study.
JOCEPS: The Journal Of Chi Eta Phi Sorority, 57(1), 24-27

Strengths
This study was written and conducted by a Nurse Executive Advanced-Board Certified DNP prepared nurse.
The article was relevant to the topic and written recently within the past 5 years.
The study determined that fall prevention programs are useful in identifying and reducing risks of falls in
hospitals. The study also determined a high prevalence of falls were related to particular medical diagnoses and
medications used in treatment.

Weaknesses
The study would have been more meaningful if it encompassed multiple hospitals in different areas.
The study focused only on nursing staff in playing a role in implementing fall prevention programs.
The study looked at 140 medical records of patients aged 65-97 and 138 of them were men.

Recommendations for fall prevention

based on overall findings from the articles

Clear communication and discussion about fall prevention such as daily huddles, a fall prevention team, easy-to-read
signs and boards, and a layout graph of the unit
Identifying and recognizing risk factors for falls such as comorbidities, alcohol withdrawal, psychological issues, certain
medications, inadequate staffing, or lack of experience amongst team members
Frequent assessment and reassessment of patients condition and fall risk factors (that can be used in computer reports
to calculate the risk levels on a floor)
Positive reinforcement and celebration when goals are met
Debriefing and discussion after a fall occurs
Include staff in the planning and design of fall prevention strategies
Nursing staff needs to be educated on the seriousness of fall prevention
Ensure adequate equipment and staffing on units
Keep fall prevention simple: make a step by step approach
Minimize competing priorities when rolling out fall prevention on the unit
Avoid tension against leadership when implementing new fall guidelines by having leaders be extra supportive
Encouragement of hourly roundings using four Ps (Pain, Personal Needs, Position, and Placement)

Overall discussion of how the research limitations affect the

readiness of the recommendations for use in clinical practice
Because we cannot tie each and every patient to the bed, there will always be a risk for falls in the
hospital. The bottom line is there is a risk for fall and injury when patients are able to get up.
Some limitations found were the size of the units, the lack of family members and patients
interviewed, and the unmodifiable risk factors for falls.
Research and education are ongoing; thus, the continuation of research and fall reduction
implementations will help increase the readiness of hospitals to keep their patients safe.
The more units that implement these strategies, the better. It will be helpful to see what works for
bigger units as opposed to units with less beds.
Speaking with more patients and family members about what works and what doesnt will also add to
limitations found in the research.

Overall conclusion that addresses

the state of the science on fall prevention
On hospital acute care units, what is the effect of actively practicing fall prevention measures in comparison to before
these measures were activated in decreasing the amount of falls that occur?

It is important to make fall prevention a priority on all hospital acute care units. When actively practicing fall prevention
and hourly rounding, there is evidence that the amount of falls decrease. Upon implementation on a unit, it is
important to listen to staff, keep the process simple, realize it may take resources and time to perfect the guidelines,
and realize this is a continuous improvement towards patient safety.
Actively pursuing a fall campaign equipped with a multidisciplinary fall team, daily huddles, bright eye-catching signs,
assessing each patients fall risk, accurate and current documentation, appropriate staffing (including number of staff
as well as skill mix), open communication, implementing use of safety equipment such as alarms, and positive
reinforcement when the fall prevention protocols are followed has proven to be effective in decreasing the occurrence
of falls in an acute care setting. A fall campaign can continue to be modified, utilized, and improved upon, as new
interventions may emerge as effective.

References
Bechdel, B., Bowman, C., & Haley, C. (2014). Prevention of falls: Applying AACNs healthy work environment standards to a fall campaign.
Critical Care Nurse, 34(5), 75-79. doi:10.4037/ccn2014987
Bennet, P.,Ockerby,C., Stinson, J.,Willcocks ,K., Chalmers, C. (2014). Measuring hospital falls prevention safety climate.
Contemporary Nurse 47(1-2) :27-35
Hicks, D. (2015). Can rounding reduce patient falls in acute care? An integrative literature review. MEDSURG Nursing, 24(1), 51-55.
Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The real world journey of implementing fall prevention best
practices in three acute care hospitals: A case study. Worldviews On Evidence-Based Nursing, 10(2), 95-103.
doi:10.1111/j.1741-6787.2012.00258.x
Urquhart Wilbert, W. (2013). The Effectiveness of a Fall Prevention/Management Program In Reducing Patient Falls: A Retrospective Study.
JOCEPS: The Journal Of Chi Eta Phi Sorority, 57(1), 24-27.