Reduce Falls. Period.

Davenport RD, Vaidean GD, Jones CB, Chandler AM, Kessler LA, Mion LC, Shorr RI.  Falls following discharge after an in-hospital fall. BMC Geriatr. 2009 Dec 1; 9:53.

Abstract:  Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. The researchers identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were

Hill EE, Nguyen TH, Shaha M, Wenzel JA, DeForge BR, Spellbring AM. Person-environment interactions contributing to nursing home resident falls. Res Gerontol Nurs. 2009 Oct; 2(4):287-96

Abstract:  Although approximately 50% of nursing home residents fall annually, the surrounding circumstances remain inadequately understood. This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls. Focus groups were conducted at two nursing homes in the mid-Atlantic region with the highest and lowest fall rates among corporate facilities. Two focus groups were conducted per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. Three categories under the Person theme were Change in Residents' Health

According to the Joint Commission (1) , one of the leading root causes of fatal falls is inadequate staff monitoring (i.e., irregular observation of at-risk patients). To ensure the continual observation of patients at fall risk, we present a list and description of available monitoring strategies and a decision matrix for selecting among these monitoring strategies.

Using the above options, use your patient's mobility and mental status to decide which combination of monitoring strategies may be appropriate:

Caution! Matrices provide a familiar format which is easy to understand but may oversimplify some decisions about monitoring strategies. In some patients there may be more elements to consider than mental and mobility status that can influence the appropriate monitoring strategy. 

Reference 1:  Strategies for addressing the root causes of falls. In I.J. Smith (Ed.), Reducing the risk of falls in your health care organization (pp. 29-50). Oakbrook Terrace, IL: The Joint Commission on Accreditation of Healthcare Organizations, 2005.

Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev. 2010 Jan 20 ; (1) : CD005465.

Abstract:  Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. The purpose of this review is to assess the effectiveness of interventions designed to reduce falls by older people in nursing care facilities and hospitals.

The most commonly used measure to track falls is “fall rate” and is calculated as follows:

Number of patient falls/ Number of patient days x 1,000

The fall rate for a specified time period is defined as the total number of falls divided by the total number of patient days, multiplied by 1,000 to create a rate per 1,000 patient days. All falls are included in the formula, not all patients who have fallen, so that repeated falls experienced by the same patient are included in the numerator. The National Quality Foundation (NQF) and other benchmark reporting organizations use this rate.  Other fall rate measurements used include: