A Nurse-Friendly Approach to Fall Prevention in Hospitals

Patient falls are dangerous to patients, to staff, and to your hospital’s bottom line.

Approximately 3% of hospitalized patients fall during their hospital stay. About one-quarter of these falls result in injury – some, minor; some, extremely serious. Not infrequently, staff suffer injuries as well while assisting patients who have fallen. The economic cost of a fall varies, but the Joint Commission estimates that the average cost of a hospital fall that results in injury is $14,000. 

Despite widespread awareness that preventing falls is a smart move, they still happen more often than anyone would like. Part of the problem? Fall prevention strategies that don’t take into consideration the challenges faced by frontline nurses. If you really want to know how to prevent falls in the hospital, you must tap into the expertise and experience of your clinical nursing staff. 

Hourly Rounding as a Fall Prevention Strategy

The Agency for Healthcare Research and Quality lists scheduled hourly rounds as a Best Practice in Fall Prevention. The available evidence supports this assertion. Research on hourly rounding at 14 hospitals revealed significant improvements:

  • 52% reduction in patient falls
  • 37% reduction in call light use
  • 14% decline in skin breakdown
  • 12% increase in patient satisfaction scores

Experts believe these positive results occurred because nursing staff were able to proactively address patient needs – pain control, toileting, and repositioning, among others – during hourly rounds. 

However, a 2019 study published in Clinics of Geriatric Medicine notes that “difficulties with adherence and sustainability of rounding initiatives are widely reported,” with the authors concluding that the “feasibility of the strategy as a sustainable fall prevention practice is uncertain.” 

A 2015 study published in Nursing that compares the results of an hourly rounding initiative on two different patient care units provides additional insight. Unit 1 experienced a significant decrease in patient falls after implementation of hourly rounding, from a baseline of 3.9 falls per 1000 patient days to 1.3 falls per 1000 patient days. Unit 2, however, did not experience a significant decrease. Unit 2’s baseline fall rate was 2.6 falls per 1000 patient days. One month after implementation of hourly rounding, Unit 2’s fall rate was 2.5 falls per 1000 patient days.

The difference between the two units? Nurse involvement. Unit 1 involved frontline nursing staff in the planning and implementation of hourly rounding. Unit 2 did not. 

Nurses Need Flexibility to Adapt Rounding to Reality

The authors of the Nursing study that reported differences in the effectiveness of hourly rounding as a fall prevention strategy noted that “the active involvement of leadership and front-line staff in program design and as unit champions … was critical to significantly reducing inpatient fall rates.”

If you want nurses to visit patients hourly (or every other hour), focus your attention on nurse/patient interaction. Electronic nurse rounding software can help hospital leaders and frontline staff determine a baseline for nurse/patient visits, allowing staff (and leaders) to better understand current patterns of practice and clinical challenges. With this information in hand, staff can then work to increase the frequency of patient check-ins (if necessary) or brainstorm ways to streamline care, so staff members don’t have to pop into the same room dozens of times each shift. 

To create a nurse-friendly rounding initiative that will decrease patient falls, solicit the input of your nurses, use nurse rounding software to determine patterns of activity, and collaborate with nursing staff.