Make best practices today’s common practices.

In 2022, Schoberer and colleagues conducted a comprehensive review of fall and injury prevention research. The findings and recommendations confirm that many current practices required of nurses at the point of care don’t effectively reduce falls and should be replaced by evidence-based interventions and patient education.

Based on the authors’ analysis, all patients should receive screening and assessment for fall risk. However, they didn’t recommend an assessment tool. The authors cited studies that show these tools have no effect on falls or fall-related injuries and that many commonly used tools don’t achieve the required values of at least 80% sensitivity and specificity. In other words, tools don’t prevent falls; nurses and interprofessional staff do when their practice is grounded in clinical judgement, expertise, and evidence-based individual and population fall prevention, injury prevention, and patient safety protocols.

Many healthcare professionals rely too heavily on tools, scores, and categories of risk when designing fall prevention care plans. We also rely too much on the universal application of fall prevention strategies, such as bed alarms and non-skid socks. Most fall risk assessment tools haven’t been correctly used or evaluated against the type of fall they’re designed to predict—anticipated physiological falls.

In 2001, the Veterans Health Administration (VHA) national fall prevention cognitive aid eliminated the need for fall risk screening at each shift. Instead, the VHA correctly implemented the Morse Fall Scale as a screening tool (not an assessment tool). VHA’s nursing practice policies, procedures, education, and electronic health record (EHR) templates guide nurses from fall risk screening to assessment and the selection of interventions based on risk factors. The following best practices can help support your patient safety efforts.

• • Interventions aligned with correctly assessed environmental and individual fall risk factors should eliminate (or at least mitigate) risks. This requires precision and the use of innovative technology.
  • Environmental- individual-, and population- specific assessments require clinical nursing skills and competencies and EHR templates with clinical pathways from screening, assessment, and care planning through the evaluation of each patient’s response as well as the mitigation, elimination, or compensation of risk factors.
  • Universal or score-based use of bed alarms has created an unnecessary burden on nursing staff and a patient-perceived restrictive environment. Innovative technology exists to support clinical indicators for using telesitter systems and position-sensors.
  • Interventions that protect patients from injury are distinct from fall prevention. In 2008, Boushon and colleagues introduced Transforming Care at the Bedside, the first national population-based fall injury prevention toolkit. It’s been deployed throughout Veterans Administration hospitals and long-term care facilities.
  • Standard of care should facilitate the use of interventions that protect patients from injury. For example, floor mat use should be common practice.

Make a commitment to change. Conduct a fall and fall injury program evaluation and begin the process of replacing common practices with best practices.

Patricia A. Quigley is a nurse consultant and president of Patricia A. Quigley Nurse Consultant LLC

American Nurse Journal. 2024; 19(9). Doi: 10.51256/ANJ092488

References

Boushon B, Nielsen G, Quigley P, Rutherford P, Taylor J, Shannon D. Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries from Falls. Cambridge, MA: Institute for Healthcare Improvement; 2008.

Health Research & Educational Trust. Facing the Facts About Falls in Hospitals. cynosurehealth.org/wp-content/uploads/2018/09/stop-to-start-improving-fall-injuries-feb-2018.pdf

Hester AL, Davis DM. Validation of the Hester Davis scale for fall risk assessment in a neuroscience population. J Neurosci Nurs. 2013;45(5):298-305. doi:10.1097/JNN.0b013e31829d8b44

Neily J, Quigley PA, Essen K. Implementation Guide for Fall Injury Reduction: VA National Center for Patient Safety. Reducing Preventable Falls and Fall-related Injuries. Veterans Administration. 2015. patientsafety.va.gov/docs/fallstoolkit14/falls_implementation_%20guide%20_02_2015.pdf

Quigley PA, Votruba L, Kaminski J. Outcomes of patient-engaged video surveillance on falls and other adverse events. Clin Geriatr Med. 2019;35(2): 253-63. doi:10.1016/j.cger.2019.01.005

Schoberer D, Breimaier HE, Zuschnegg J, Findling T, Schaffer S, Archan T. Fall prevention in hospitals and nursing homes: Clinical practice guideline. Worldviews Evid Based Nurs. 2022;19(2):86-93. doi:10.1111/wvn.12571

U.S. Department of Veterans Affairs. VHA National Center for Patient Safety: Falls toolkit. patientsafety.va.gov/professionals/onthejob/falls.asp