Risk Profile: Care – Falls

Risk Profile: Care  Falls (PDF version)

Falls prevention is identified as a safety priority.  Falls may lead to significant harm to patients, may increase the risk for early death, and can make it difficult for individuals to live independently. Many risk factors can be changed or modified to reduce the risk of falls and falls-related injuries. Reducing injuries from falls can increase quality of life for patients. This document contains information entered by your peers in the Risk Register application to help you manage this risk.

Ranking/ratings[1]

  • Likelihood – average score 3.31
  • Impact – average score 3.24

The Risk Register allows for risks to be assessed on a five-point likelihood and impact scale, with five being the highest.

Key controls/mitigation strategies

  • Care practices
    • Implementation of a falls prevention approach for inpatients and outpatients which may include:
      • identification of the population(s) at risk for falls (standardized risk assessment to determine mobility status e.g. Morse falls scale)
      • identification and implementation of a standardized intervention algorithm based on assessment findings
      • measurement and evaluation of the falls prevention approach on an ongoing basis
      • information from the evaluation used to make improvements to the falls prevention approach
    • Adopt definition of a patient fall
    • Develop and implement patient falls prevention and least restraint policies; ensure regular policy reviews and compliance audits
    • Engage patients and families in falls prevention strategies, including: prompt discussions, one-on-one, visits, etc.
    • Establish a falls working group/team with interprofessional representation from highest risk areas to support ongoing organizational focus
    • Understanding of delirium/dementia related to falls and prevention strategies
    • Standard falls risk screening tool to assess patient risk for falls:
      • upon admission or within 24 hours of admission
      • after transfer to another unit or program
      • after a significant event
      • following a change in health status
      • after fall resulting in injury
    • Assessment and mitigation of environmental falls hazards (e.g. during regular observation rounding)
    • Conduct home safety falls risk assessment in patient/client homes
    • Communicate falls risk status and patient specific safety strategies to the healthcare team, patient, and family
    • Provide education and training on falls risks and falls prevention strategies to staff, patient and family
    • Adopt early mobilization strategies and practices
    • Interventions/strategies in place to reduce risks for falls:
      • non-slip socks
      • commonly used items are within reach (e.g. tissues, water)
      • Q1-2 hour rounding
      • call bell instructions posted
      • falls sticker on chart and patient's bed
      • falls armbands to increase staff awareness
      • falls precaution signage posted (e.g. magnet that goes outside the room to identify to the entire team that the patient is a falls risk)
      • review and avoid medications that may place patient at falls risk
      • move high-risk falls patients closer to nursing station
      • assess appropriateness of sleep environment
      • asses physical environment layout
  • Equipment
    • Equipment used to reduce likelihood of falls or injury due to falls:
      • bed and chair alarms
      • hip guards
      • motion alarms
      • wheelchairs
      • increased use of cribs vs. stretchers
      • walkers, canes
      • ensure that beds can assume low position in order to assist with transfer out of bed and/or reduce impact of potential fall
    • Assess and update falls mitigation equipment (e.g. preventative maintenance)
  • Post-fall management
    • Conduct post-fall debriefings to identify gaps and share learnings
    • Regular meetings to review fall incidents
    • Review pertinent falls events during morbidity and mortality committee meetings

Monitoring/indicators

  • Develop falls indicators for all settings, including ambulatory
  • Review patient/family complaints about falls
  • Review patient experience survey results – falls prevention
  • Number of falls incidents by severity submitted in the incident reporting system
  • Document all witnessed and unwitnessed falls in event management system, review trending data
  • Audit process in place to confirm compliance of falls risk assessment completion and documentation; regular review of audits mechanisms
  • Fall metrics may include:
    • percentage of witnessed falls
    • percentage of falls with harm (number of days between)
    • percentage of falls without harm
    • falls/1000 patient days
    • falls with harm/1000 patient days
    • percentage of falls due to multiple fallers
    • percentage of falls with harm due to multiple fallers
    • percentage of falls linked to toileting to total falls
    • percentage of falls with mention of restraints as cause or intervention
    • percentage of inpatients with completed falls risk assessment on admission
    • falls assessment completion rates
  • Flag repeat falls
  • Track multiple fallers and patient specific huddles for alternate interventions
  • Falls metrics monitored in the Quality Improvement Plan (QIP), quality scorecards
  • Quarterly reporting on falls indicators to the Quality Committee of the Board
  • Restraint audits and appropriate use
  • Incorporate daily falls compliance/monitoring into unit huddles

[1] As of January 1, 2017

Note: information presented in this document has been taken from the shared repository of risks captured by HIROC subscribers participating in the Integrated Risk Management program.

© 2018 HIROC. For quality assurance purposes.