Falls risk assessment, identification and intervention(s) are performed in practice to minimize risk of injury and ensure patient safety
- Fall-related injuries are a significant health concern in Canada and result in substantial economic burden to society.1,2
- Falls are a common adverse event reported in hospitals3
- Falls are experienced by more than 1/3 of seniors which can have significant impacts1,2
- The risk of falls increases with more risk factors and a diagnosed history of falls or cognitive impairment4
- All health care teams are now required to implement and evaluate a fall prevention strategy to minimize the impact of falls.1
- Identifying possible risk factors and falls prevention programs can prevent the majority of falls.
- Fall risk assessment is a process that can strengthen an MRT’s ability to keep patients safe within their daily practice.
- Falls risk assessment tool(s) used should be appropriate for patient setting and the appropriate population.
- MRTs should ensure that universal falls risk interventions are adhered to at all times.
- MRTs should assess all patients for individual falls risk as per institutional policy and provide interventions as needed/necessary.
- Falls risk assessment will include validated tool and/or clinical judgement through observation.
- Considerations when assessing patients may include: 3,5,6
- Age (seniors >75 years)
- History of recent fall(s)
- Vision (decreased)
- Specific comorbidities (i.e., hip fracture, Parkinson’s disease, dementia)
- Functional disability
- Gait, balance or visual impairment
- Certain medications/drugs that may affect balance (i.e., sedatives, hypnotics)
- Physical restraints
- Altered mental state, confusion, impaired cognitive abilities
- Bare feet or inappropriate footwear
- General safety precautions in hospitals, clinics and other facilities may include: 3,5
- A facility protocol/falls referral program
- Use of adjustable hospital beds, equipment
- Use of floor mats at risk for injury, i.e., osteoporosis
- Access to a call button
- Increased observation/surveillance
- Recommendation of proper foot wear
- Reduction of traffic
- Surveillance of the environment
- The environment is routinely assessed for risk factors that can contribute to falls and appropriate actions are taken to mitigate these risks. Environmental factors to assess include: 3,5
- Floor surfaces (slippery, wet, uneven)
- Lighting and proper functioning of light sources
- Furniture, assists (i.e., IV poles) and equipment are in good condition (sturdy)
- Tripping hazards
- Falls prevention intervention programs when used in practice by health care providers can reduce falls and related injury.2
- Falls risk assessment, risk and interventions are documented according to institutional requirements.
- Appropriate measures are taken by the appropriate health care provider to treat, monitor and follow up with the patient as required.5
- All measures should be taken to report and improve policies and procedures based on intervention results.5
- Documentation should ensure that information is available to the interprofessional team and that patients at increased risk of falling are flagged.
- Follow up on falls reporting according to institutional/facility policy.
- Be familiar with falls risk reduction and prevention policies and procedures at their institution and complete any training as required or recommended.
- Ensure that universal falls interventions are adhered to for all patients and in all patient settings to prevent future falls.6
- Communicate risk factors through appropriate channels (health care team, patient, family).
- Ensure that appropriate awareness mechanisms are available to patients, for example, patient education materials (pamphlets and posters).5,6
- Understand that patient fall risk status can change at any time during the course of a treatment or examination.
Accreditation Canada, Canadian Institute for Health Information, The Canadian Patient Safety Institute. Preventing Falls: From Evidence to Improvement in Canadian Health Care. CIHI. 2014. Available from: https://secure.cihi.ca/free_products/FallsJointReportAugust6_2014_CPHI_EN_web.pdf. [Accessed 19 Dec 2017]
Canadian Patient Safety Institute. Reducing Falls and Injuries from Falls. CPSI. 2013. Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Reducing%20Falls%20and%20Injury%20from%20Falls/Falls%20One%20Pager.pdf. [Accessed 3 Jan 2018]
Degelau J, Belz M, Bungum L, et al. Prevention of Falls (Acute Care). Institute for Clinical Systems Improvement (ICSI). Updated: April 2012.
Al-Aama T. Falls in the elderly; Spectrum and prevention. Can Fam Physician. 2011 July;57(7):771-776. Available from: http://www.cfp.ca/content/57/7/771.full. [Accessed 3 Dec 2018]
Gray-Micelli D, Quigley PA. AHRQ Guideline Summary NGC-9721: Fall prevention in Evidence-based geriatric nursing protocols for best practice. 4th ed. ResearchGate. 2012. Available from: https://www.researchgate.net/publication/263542284_Gray-Miceli_D_National_Guideline_Clearinghouse_Guideline_Summary_Preventing_falls_in_acute_care_website_In_Evidence-based_geriatric_nursing_protocols_for_best_practice_Rockville_MD_cited_10808_Availab. [Accessed 3 Jan 2018]
Registered Nurses Association of Ontario. Prevention of Falls and Falls Injuries in the Older Adult. RNAO. 2011. Available from: http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf. [Accessed 3 Jan 2018]