Many patients don’t consider themselves to be at risk of falling in a hospital.
After all, hospitals are places where educated professionals work to protect patients’ health and well-being. But the risk of falls during hospitalization is significant, as most patients are weak, uncomfortable, and in an unfamiliar environment.
Patient falls are the most common adverse events reported in hospitals, with approximately one in four hospital falls resulting in injury, and one in ten resulting in serious injury. Sadly, patient falls in U.S. hospitals appear to be increasing. Patient falls increased 27% from 2021 to 2022, according to the Joint Commission.
National Falls Prevention Awareness Week is September 18-22 this year. While patients certainly do not bear complete responsibility for their safety during hospitalization, they have a vital role to play. Understanding patients’ perceptions of fall risk can help you direct fall prevention strategies and decrease patient harm.
Patient Perceptions of Fall Risk During Hospitalization
Researchers have noted “a disparity between [patients’] perceived fall risk and their clinical risk of falling” during hospitalization. To better understand patients’ perceptions, a group of Australian researchers interviewed 18 patients (average age: 69.8 years) at three Western Australia hospitals. They discovered a few common themes:
“Extrinsic influences such as nursing staff supervision and call buzzer technology were considered the main components to fall prevention in hospitals.”
Patients recognized that “assistance by nursing staff eliminated the need for risk-taking behaviors.” Nearly every patient realized that attempting to get out of bed independently was riskier than asking nursing staff for assistance, and most patients said they “would not hesitate to seek assistance,” even though several individuals were fiercely independent in daily life.
But like patients the world over, the Australian patients’ calls for help weren’t always promptly answered. They expressed frustration with slow or unanswered buzzers, while also expressing deep empathy for the nursing staff. The researchers wrote that patients “recognized…low staffing issues” and some were “wary of using their call buzzer and cited altruistic reasons for not wanting to seek assistance.”
“Patients demonstrated awareness of the possible consequences of falling.”
All patients realized that falls could have profound consequences, including soft tissue injuries, fractures, head trauma, and even death. Older patients also knew that the consequences of a fall can limit mobility and complicate daily life after hospitalization. Because patients understood the potential harm of falls, they “appreciated the significance of falls prevention.”
Patients consider technology “essential to staying safe in hospital.”
All patients appreciated the ability to electronically summon help when needed, and one even mused aloud about the possibility of electronic monitoring, saying, “There needs to be…like an electronic tracking bracelet that they would put on patients and nurses…”
Patients are not opposed to the use of technology. In fact, they welcome technological advances that can enhance safety.
Involving Patients in Proven Falls Prevention Strategy
According to the Joint Commission, patient falls during hospitalization most often occur during ambulation. Patient falls during toileting are also common. Assistance during ambulation and toileting can prevent many falls.
Joint Commission researchers also cited a “lack of shared understanding or mental model regarding plan of care” as a contributing factor for many patient falls. Plainly stated: patients and nursing staff may not share the same understanding of the patient care plan. Patients don’t exactly know when or how nursing staff plan to assist them.
Regular, intentional rounds are an Agency for Healthcare Research and Quality (AHRQ)-recommended falls-reduction tactic that many hospitals have used to significantly reduce patient falls. During hourly rounds, nursing staff (RN, LPN, or nursing assistant) check on each patient and:
- Ask about their pain (and deliver comfort measures, if needed)
- Offer toileting assistance
- Reposition the patient, if needed
- Make sure the bed is locked and in low position
- Ensure that the telephone, TV remote, light switch, call light, tissue box, water, and any personal aids (such as glasses and hearing aids) are within reach
- Ask if the patient needs anything else
- Tell the patient that nursing staff will round again in one hour.
Discussing fall risk and educating patients about nurse rounding on admission – and each shift thereafter – creates a partnership between nurses and patients that can keep patients safe. Because patients know when they can expect help, they’re less likely to take chances and attempt independent ambulation or toileting. According to a study published in Controlled Clinical Trial, purposeful nurse rounding decreased patient falls by 52%.