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Risk management for healthcare entities: Fall and injury prevention

Healthcare entities have the duty to ensure the physical safety of patients under its care. Patient falls can have consequences that ripple across the healthcare system, including serious patient injuries, prolonged hospital stays, delayed rehabilitation, and increased healthcare costs.

The World Health Organization describes the framework for maintaining patient safety as “[…] cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely, and reduce impact of harm when it does occur.”

To maintain patient safety and prevent fall-related injuries, healthcare entities must first understand the range of risks that exist in the physical environment and then take action to address them with a comprehensive risk management plan. With effective controls and a holistic risk approach in place, healthcare entities can deliver the highest quality care and prevent unnecessary harm to all patients under their care — particularly those at high risk of falling.

The following guidance highlights key risk controls healthcare entities may implement to prevent patient falls and mitigate associated harm. It is not an exhaustive list and should be used in conjunction with policies and procedures and professional standards, as well as in compliance with local laws and regulations.

Code of conduct

Amending your code of conduct to include specific guidance, best practices, policies, and procedures for fall and injury prevention will be essential to educating healthcare professionals and ensuring the safety of patients under your care.

Develop and review, at least annually, a comprehensive suite of policies and procedures that addresses the following:
- An organization-wide commitment to ensuring the safety of all patients, especially those considered high-risk, and preventing falls and associated injuries
- Establishment of where policies and procedures are enforced
  - Expected accountability of healthcare professionals, including:
  - Employees (For example, nursing and allied health)
  - Independent practitioners (For example, physicians and midwives)
    - Students
- Ensure that training regarding the policies is mandatory for all individuals and groups
- Ensure policies and procedures are easily accessible to all individuals and groups

Care plan

Patient care plans should clearly define the actions necessary to ensure a safe healthcare environment, reduce the risk of avoidable harm, and enhance patient care overall. These plans should include interventions that address the following five areas:

Assessment

Complete and document fall risk screening and assessments, which consider a patient’s unique circumstances including:
- Pain
- Bed positioning
- Personal needs (For example, toileting, hydration, and/or eyeglasses)
- Equipment needs (For example, commode, urinal, walker, and/or cane)
- Equipment placement (For example, call bell, phone, and/or reading materials)
- Incident history, including all details leading up to the incident, condition of patient, and any injuries sustained
Adopt measures to identify high-risk patients and enable staff to introduce proper safety measures:
- Armbands (For example, colored arm bands)
- Socks (For example, non-skid socks)
- Signage (For example, door and bed signage)
Obtain required mobility equipment/assistive devices required for the care plan to prevent falls, which may include:
- Walkers
- Canes
- Commodes
- Urinals
- Bed rails
- Floor cushions
- Call bells
- Bed alarms
- Phones
- Eyeglasses
- Reading materials

Rounding

Implement a regular rounding schedule of identified falls high-risk patients, with check-ins by healthcare professionals on call at the following times:
- Start/end of work shift
- Entry/return to bed
- Set time intervals, as needed (For example, hourly)
Inform the patient of the frequency of the rounding to be conducted
During rounding, conduct the following activities:
- Assess patient for the following:
  - Pain
  - Confusion
  - Discomfort
- Confirm the following identifying measures are in place:
  - Arm bands
Door or bed signage
- Ensure the patient is using correct footwear:
  - Non-skid Shoes/slippers
  - Non-skid socks
  - Confirm the bed is placed in the lowest position per recommended treatment plan
  - Ensure the following mobility equipment/assistive devices are within reach:
  - Walker
  - Cane
  - Commode
  - Urinal
  - Bed rails
  - Call bell
  - Phone
  - Eyeglasses
  - Reading materials
  - Tissue box
  - Garbage can
- Offer toileting and hydration assistance

Medication

Initiate a medication review for any patient who has a fall, to identify any medicines that may be contributing to their risk of falls
Review medication of patients that are at risk for falls and suggest alternative medications or dosages to medical providers

Mobility

Evaluate the safety of the patient's environment during care and mobility activities
Document and advise the healthcare team of any changes to the patient’s alertness, coordination, balance, and mobility that may put them at higher risk of falls
Make recommendations and train patient to use the following:
Mobility aids
Assistive devices
Provide physical therapy to patients to improve mobility and ability to perform daily activities

Training

In order to maintain patient safety and prevent falls in the healthcare environment, it is essential that healthcare professionals participate in comprehensive and standardized training. All training development, review, and updates should be in alignment with organizational, professional, and ethical standards:

Education for employees, independent practitioners, and students

Develop a role-based training program that enhances awareness and understanding of fall and injury prevention. Specifically, the training should address the following:
- Identifying and supporting at-risk patients
- Integrating care plans and treatment
- Conducting patient and family education
- The consequences of non-compliance with policies and procedures
- Proper procedures for reporting and responding to a patient safety incident
Establish a training schedule, with onboarding and frequent refresher trainings for the following parties:
- Employees (For example, nursing and allied health)
- Independent practitioners (For example, physicians and midwives)
- Students

Education for patients and families

Develop a comprehensive patient and family education program that enhances understanding of fall and injury prevention. It can enable the patient and their family to actively participate in patient care and take preventative measures where required. Specifically, the training should address the following:
- Identifying and supporting at-risk patients
- Identifying falls risks and hazards, such as:
  - Indoor areas
    - Uneven surfaces or edges
    - Cracks, bulges, breaks, or tears
    - Exposed cords and cables
    - Garbage and other debris
  - Stairs and ramps
- Uneven surfaces or edges
  - Cracks, bulges, breaks
  - Garbage and other debris (For example, leaves and branches)
  - Installing appropriate safety measures, such as:
  - Anti-slip surface/strips on surface, ramps, and bathroom floors/tubs
  - Adequate lighting lumens/brightness
  - Contrasting color strips on step edges
  - Sturdy and secured handrails, barriers, and railings

Summary

As part of their responsibility to deliver safe and quality healthcare services, healthcare entities must take the appropriate measures to prevent patient falls and injuries on their premises. An effective risk management strategy can help align healthcare providers under comprehensive policies and procedures, while educating patients and their families about how to minimize preventable falls and mitigate their associated risks. By prioritizing fall prevention, healthcare entities can continue to deliver a high quality of care, mitigate unnecessary harm, and create a safe and secure environment for all patients.

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