_____________________________________________________________________ Falls and Fall Prevention
While many precautions are of benefit to all patients in pre- venting falls, the AHRQ recommends fall prevention measures should be individualized, considering the patient’s age, fall history, and risk factors. The goal is to assure patient safety from falls, preventing additional harm during the period of hospitalization. Outpatient clinic administrators and staff can use similar prevention measures to ensure patient safety against falls in the home [21].Although the following precautions were developed for reducing risk of inpatient falls, they may be applicable to the ambulatory clinic and home environment as well [21]: • A call light within reach and instruction to the patient on proper use • Sturdy handrails in restrooms, patient rooms, and hallways • Hospital or exam tables in the lowest position, with brakes locked • Wheelchair locks used when inactive • Appropriate footwear (e.g., nonskid soles, avoiding slippers with open backs or open-toed sandals) • Appropriate supplemental lighting • Clean and dry flooring • Safe handling practices of patients, including assistance with transferring and ambulation Fall Prevention Programs Inpatient or resident fall prevention programs have been implemented broadly, often in association with regular exercise routines for residents of long-term care facilities. Hospital interventions have been demonstrated as effective for decreasing fall rates [20]. The AHRQ Fall Prevention in Hospitals training program supports staff in the development and implementation of their own fall prevention programs with standardized tools to prevent falls [21]. The training consists of five modules with various practices, including information on why change is needed and how to manage change, best practices in fall prevention, how to implement the program, and how to measure fall rates [21]. The AHRQ training program also addresses discharge planning, including strategies for fall prevention after discharge of at-risk patients back into the community.
The World Falls Guidelines Task Force recommends providing advice on how to maintain safe mobility and optimize physical functioning to older adults at low risk of falls from a clinician trained to do so. Such advice should consider the circumstances, priorities, preferences
and resources of the older adult. This advice should reinforce health promotion/prevention messaging relevant to falls and fracture risks such as those on physical activity, lifestyle habits and nutrition including vitamin D intake. (https://academic.oup.com/ageing/article/51/9/ afac205/6730755. Last accessed March 26, 2024.) Strength of Recommendation/Level of Evidence : E (Expert opinion) INPATIENT AND RESIDENT FALL PREVENTION PRACTICES The Agency for Healthcare Research and Quality (AHRQ) estimates that each year between 700,000 and 1 million people in the United States fall in the hospital [21]. Many of these falls cause fractures, lacerations, or internal bleeding, leading to increased healthcare utilization. Fall prevention involves managing a patient’s underlying fall risk factors and optimizing the facility’s physical design and environment [21]. The AHRQ has developed hospital training programs, a fall prevention toolkit, and other materials to help inpatient facilities overcome the challenges associated with developing, implementing, and sustaining a fall prevention program [21]. Fall risk assessment and preventive interventions should start at initial admission to the hospital or long-term care facility. Within hospitals, bed alarms, sitters, and physical restraint orders have been used in the past to reduce the likelihood of patients falling [17]. However, restraints have been noted to pose an increased risk for severe injury (and aspiration) and are used only very rarely. Restraints must have 1:1 observation and a physician order [28]. While employing a bedside sitter seems a reasonable precaution, one study found that evidence is inconclusive whether the presence of a sitter decreases the number of falls [16].
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