Implementing a successful falls prevention program requires a systematic method for identifying patients or residents who are at a higher risk for falling, so that fall prevention resources can be targeted where they are most needed.
When to conduct a risk assessment
The assessment for risk factors, which is usually performed by nurses, commonly utilizes a system that assigns points to specific risk factors. The level of risk and subsequent fall precaution measures such as “standard” or “high risk” precautions are then initiated based on the range in which the patient scores (e.g., low, medium or high risk).
Suggested timing for risk assessments include:
- On admission
- Changes in a patient's status
- Whenever a fall occurs
- Periodically during a hospital stay, or when transported
- Quarterly, at minimum, or other defined time periods in long-term, chronic and residential care settings.
Instruments to conduct a risk assessment
A comprehensive list is available for fall risk factor elements that have been incorporated in various instruments. The particular variables one would include in a risk assessment instrument depend on the patient characteristics of the particular healthcare setting.
The Morse Fall Scale is a relatively easy instrument to use and has been demonstrated to be reliable and valid across a variety of healthcare settings (acute medical and surgical units, long term care areas, rehabilitation hospitals).
Additional instruments and tools for preventing patient falls are available from the Department of Veterans Affairs National Center for Patient Safety (VA NCPS).
Organization of risk assessment information
Depending on the assessed fall risk of patients or residents using the MFS or other scales, the next essential part of a successful falls prevention program is to organize and implement patient-specific fall prevention strategies. One Falls Assessment Chart is also available from the Foundation of Nursing Studies Web site. This excellent algorithm depicts the full circle of activities initiated by the assessment.
- Fall assessment is implemented shortly after hospitalization.
- Level of fall risk is determined.
- Patient-specific fall prevention strategies are organized.
- Prevention strategies are implemented.
- Communication of key players and fine-tuning of plan.
- Formal fall reassessment.
A similar approach to fall risk assessment considers all factors that place the patient or resident at risk for injury. Such as assessment includes falls as one preventable injury among others. For example, the Detroit Medical Center (DMC) has instituted such a patient injury assessment tool and implemented a related policy.