Fall prevention in healthcare involves managing patients’ underlying risk factors and optimizing their environment to reduce the likelihood of an unplanned descent to the floor. Implementing a comprehensive fall-prevention toolkit like Fall TIPS has been shown to effectively reduce the occurrence of this common patient safety event.
A hospital is an unfamiliar setting, and every patient is there because of an illness or condition that requires treatment. This environment increases the likelihood of falls, which are among the most common and devastating events in any hospital.
While the rate of falls varies among hospitalized adult patients depending on the study, multiple studies indicate that 3-4 falls occur per 1,000 bed days. A fall, especially by geriatric patients, can be the start of a downward spiral, as described by the team that did early research on the use of a fall prevention toolkit. A single fall can have compounding effects and result in fear of falling, reduced mobility, loss of function and greater risk of falls.
That early research, published in the Journal of the American Medical Association in 2010, found a significantly reduced rate of falls in the hospital setting when a fall prevention toolkit was added to usual care protocols. Over the next decade, and funded through a grant by the Agency for Healthcare Research & Quality (AHRQ), that research team would go on to further refine their toolkit to help facilities prevent falls. And the toolkit resulting from all that work — Fall Tailoring Interventions for Patient Safety (Fall TIPS) — was recently released for free.
In a more recent 2020 JAMA study, involving over 37,000 patients, Fall TIPS was tested at Brigham and Women’s Hospital in Boston and two other facilities. The results were striking: falls with injury were reduced by 34%, and total falls decreased by 15%. Since then, the fall prevention toolkit has been implemented in more than 100 hospitals in the U.S. and internationally, making it a proven solution for enhancing patient safety.
When Fall TIPS fall prevention toolkit was first developed, the use of this nurse-led, evidence-based solution proved to reduce falls by 25% in acute care settings when integrated as part of electronic record-keeping. The Fall TIPS team then set out to create a “low tech” tool that offered the same benefits in preventing falls: a laminated poster that offers the same benefits in preventing falls without the need for IT involvement.
In the EHR version, the patient’s risk factors and tailored interventions automatically populate the Fall TIPS electronic poster, which a nurse then prints and hangs in the patient’s room. While the integration into a facility’s EHR reduces the potential for error, it also requires the involvement of the IT team to set up. The lower-tech, laminated poster version, on the other hand, can easily be filled out with a dry erase marker and updated daily at the bedside. A full list of the pros and cons of the paper and electronic methods can be found on the Fall TIPS site under the heading “Paper or Electronic?”.
Whether a high-tech electronic or low-tech poster version is implemented, the goal of the fall prevention toolkit is ensure that all patient care staff are aware of current risk factors and engage in preventive actions at the bedside.
The human cost of falls is only part of the story. One-third of falls result in injury, and injurious falls can add a week or more to a hospital stay. The same JAMA study from 2020 found that the additional cost was $19,376 to $32,215. These expenses are not reimbursed by the Centers for Medicare & Medicaid Services, as more than 90% of falls are preventable. To mitigate both human and financial costs, implementing a comprehensive fall prevention toolkit like Fall TIPS is essential.
To maximize the effectiveness of a performance improvement tool like Fall TIPS, it’s crucial to track and measure success for communication to the team on the frontline as well as senior leadership. The best way to accomplish this is through a Patient Safety Event Reporting Application with real-time dashboards. If your tool has a dedicated Falls Dashboard like ADN’s application (see video below), evaluating falls data pre- and post-implementation of a tool like this is much easier. Using a patient safety event reporting guide can also help healthcare teams monitor falls data efficiently.
At the patient level, the fall prevention toolkit Fall TIPS is a three-point plan of action:
The toolkit is easy enough to use that compliance was above 80% at the hospitals where it was first tested. So with administrative buy-in and training of patient-care staff, Fall TIPS can become a routine and effective part of patient care. Subsequent research shows that a compliance rate of at least 80% is necessary to realize a clinically significant reduction in falls. Using a good catch program can also help bolster prevention efforts by encouraging staff to report and correct potential hazards early.
The most visible tool in the fall-prevention toolkit is a poster placed in the patient’s room (either laminated or printed from the EHR). However, the key to successful implementation starts with administrative buy-in. This includes engaging relevant committees and champions, whether through a dedicated fall-prevention task force or a general quality and safety council. Establishing buy-in across all organizational levels is crucial for long-term success.
Part of the implementation process involves analyzing existing fall prevention protocols to identify gaps and align with best practices. The national patient safety goals guide is a helpful resource for ensuring compliance with industry standards. Fall TIPS provides an implementation checklist, gap analysis tool, and training materials for champions and nurses to support this process.
Whether using the high- or low-tech version of Fall TIPS, the fall prevention toolkit provides a personalized assessment of the patient’s risk of falling and a personalized plan to address their specific risk profile. Identifying patient risks is crucial, as it allows healthcare providers to implement effective fall-prevention strategies.
Does the patient have a history of falls? Are they taking medications that might contribute to unsteadiness? Do they already use a cane or walker? Are they likely to get out of their bed or chair without summoning help? Addressing these questions helps shape a comprehensive plan of care that includes interventions tailored to the patient’s risk profile.
Once a patient’s risk factors are identified, the next step is to incorporate targeted interventions into the care plan. For example, should the patient use a bedpan or be assisted to the toilet? How many helpers does the particular patient need to assist? Is the risk of getting up unassisted so great that a bed alarm is required? These interventions should be adjusted in real-time.
All of the risk factors and interventions should be discussed with both the patient and their family, ensuring that everyone understands the fall-prevention strategies in place. In fact, whether the patient and/or family can verbalize the patient’s risk factors and the fall-prevention plan are part of the audit questions that internal champions must answer. Patient and family feedback has affirmed that knowing the plan improves compliance and can help reduce the fear of future falls, a factor in the downward spiral of fall-prone patients.
The fall prevention toolkit Fall TIPS is not a one-size-fits-all plan for every patient, nor is it static for the individual patient. The toolkit is designed to be adaptable as the patient’s condition changes, ensuring that appropriate interventions remain relevant and effective. Risk factors and appropriate interventions should be re-evaluated daily to reflect the most current patient status. The toolkit’s poster features an assessment date, allowing care providers to see how current the evaluation is.
For example, a patient may be at greater risk of falling and need different levels of assistance immediately after surgery than before. Similarly, a change in medications may alter risk factors, necessitating adjustments in the care plan.
With consistent training and the proper use of Fall TIPS, hospitals can reduce the both the frequency of patient falls and the severity of injuries associated with falls that do happen. Daily re-evaluations and adjustments to the care plan ensure that the fall-prevention toolkit continues to provide optimal protection for patients.
With its flexibility and adaptability, the fall-prevention toolkit ensures that patients receive care tailored to their evolving needs. For hospitals ready to enhance their fall-prevention efforts, Fall TIPS is available for immediate implementation. Additionally, using ADN’s Patient Safety Event Reporting Application can further support your team by uncovering trends and patterns in fall-related data, making it easier to track progress and refine interventions over time.
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