Patients who are assessed and defined as “high risk” for a fall are put on fall precautions in the hospital. There are several different tools used to assess for fall risk. Yet No single fall-risk assessment tool has been conclusively validated. Despite the lack of evidence for falls risk assessment tools, many hospitals continue to use them. However attractive the use of such tool might be, if they do not perform sufficiently well in that setting and population, their use may be ineffectual or provide false reassurance that ‘something is being done’ to target high-risk patients while still diverting attention away from more potentially effective interventions. Oliver, Papaioannou, Giangregorio,Thabane, Reizgy and Foster (2008).

The Morse Fall Scale, St Thomas Risk Assessment Tool and Hendrich II  were validated in an inter-rater reliability and validity study in 2003. They concluded the Heindrich II Fall Risk Model is potentially useful in identifying patients at high risk for falls in acute care facilities. Kim EA, Mordiffi SZ, Bee WH, Devi K, Evans D. (2007).

The STRATIFY falls risk assessment, a prediction tool developed for use for hospital inpatients, using a 0–5 score to predict patients who will fall. It has been widely used as part of hospital fall prevention plan, but it is not clear how good its operational utility is in a variety of settings. was significantly related to incidence of accidental falls in this large cohort but was a poor predictor of falls and cannot be recommended for routine use in acute hospital settings.  Careful review of your tool is recommended. Oliver et al. (2008).

To the community, fall precautions suggest that we, as providers, have in place something that will prevent the fall from occurring. It is an expectation from the consumer’s point of view that hospitals provide staff and possible sitters to avoid any fall from occurring.  It is the consumer’s point of view if a patient falls, we are at fault. No fall is the expectation and so it should be. Nurses have more than one patient assignment, in fact, they may have up to 8 or more patients and may all be high risk for a fall. With that being said, this does not mean the nurse is not observing as he/she makes their rounds and with each encounter looks for solutions to manage the patients who may be at risk. The fact is, when the nurse leaves the room, patient falls are not an uncommon scenario played out day to day.

Falls typically occur either while the patient is getting into or out of bed or shortly after the patient has exited the bed.  Those patients that are identified as on fall precautions, or high risk for falls is the patient’s history, it is not a plan.  Where would one find the plan in the hospital? Is it in the care plan? A policy? Do all staff know the plan?  In the event of a fall, the absence of written policies can increase a facility’s liability for failure to establish patient safety policies. The goal of a fall evaluation and prevention strategy is to minimize the risk of falling without compromising mobility or functional independence. Given the inherent trade-offs between safety and independence, this goal may be difficult to achieve in some individuals. Perhaps a better goal would be to prevent relevant fall-related morbidities such as serious injury. As the ability to identify the subset of fallers at risk for these fall sequelae improves, evaluative and preventive efforts can be better targeted. A recent report done by an expert panel provides an evidence-based approach to the management and prevention of falls, (The Quality Indicators for Assessing Care of the Elderly {ACOVE, 2001} project). Family members should be a part of the care, asking a family member to stay with the patient because of a fall risk is acceptable for creating a culture of safety.  Just as important in part of a prevention program that would out line measures that are implemented to make an attempt to prevent a fall is the post fall diagnostics.

Hospitals and LTC facilities may use bed alarms for what they describe as “fall precautions” these are beds with built in alarms.  The purpose of the alarms is to alert staff that the patient is attempting to exit the bed. The alarms are activated by either pressure relieving through the mattress or motion sensors that will alarm when one goes through or over the rails. I call bed alarms a notification of patient on the floor and therefore, get lifting help. In my experience, I have not seen an alarm re-route a confused patient from exiting the bed. Unless you are within feet maybe inches, patients fall fast, not in slow motion. Bed-exit alarms do not themselves prevent falls, a fact that is not always clearly understood. To be effective, they need to be implemented with care and with a clear understanding of their limitations.

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