Preventing Falls in Hospitals

A Toolkit for Improving Quality of Care

Each year, somewhere between 700,000 and 1,000,000 people in the United States fall in the hospital. A fall may result in fractures, lacerations, or internal bleeding, leading to increased health care utilization. Research shows that close to one-third of falls can be prevented. Fall prevention involves managing a patient's underlying fall risk factors and optimizing the hospital's physical design and environment. This toolkit focuses on overcoming the challenges associated with developing, implementing, and sustaining a fall prevention program.

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Prepared for:

Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
www.ahrq.gov

Prepared by:

RAND Corporation
Boston University School of Public Health
ECRI Institute

Contract No. HHSA290201000017I TO #1

Contents

Roadmap
Acknowledgments
Overview
   The Problem of Falls
   The Challenges of Fall Prevention
   Toolkit Designed for Multiple Audiences
   Implementation Guide Organized To Direct Hospitals Through the Change Process
   Sections of the Guide
   Adaptation of the Guide to Your Organization
   Improvement as Puzzle Pieces
Icons
1. Are you ready for this change?
   1.1. Do organizational members understand why change is needed
   1.2. Is there urgency to change?
   1.3. Does senior administrative leadership support this program?
   1.4. Who will take ownership of this effort?
   1.5. What kinds of resources are needed?
   1.6. What if you are not ready for full-scale change?
   1.7. Checklist for assessing readiness for change
2. How will you manage change?
   2.1. How can you set up the Implementation Team for success?
   2.2. What needs to change and how do you need to redesign it?
   2.3. How should goals and plans for change be developed?
   2.4. Checklist for managing change
3. Which fall prevention practices do you want to use?
   3.1. Which fall prevention practices should you use?
   3.2. What are universal fall precautions and how should they be implemented?
   3.3. What is a standardized assessment of risk factors for falls, and how should this assessment be conducted?
   3.4. How should identified risk factors be used for fall prevention care planning?
   3.5. How should you assess and manage patients after a fall?
   3.6. How can your hospital incorporate these practices into a fall prevention program?
   3.7. What additional resources are available to identify best practices for fall prevention?
   3.8. Checklist for best practices
4. How do you implement the fall prevention program in your organization?
   4.1. What roles and responsibilities will staff have in preventing falls?
   4.2. What fall prevention practices go beyond the unit?
   4.3. How do you put the new practices into operation?
   4.4. Checklist for implementing best practices
5. How do you measure fall rates and fall prevention practices?
   5.1. How do you measure fall and fall-related injury rates?
   5.2. How do you measure fall prevention practices?
   5.3. Checklist for measuring progress
6. How do you sustain an effective fall prevention program?
    6.1. Who will be responsible for sustaining active fall prevention efforts on an ongoing basis?
    6.2. How will you continue to monitor fall rates and fall prevention care processes?
    6.3. What types of ongoing organizational support do you need to keep the new practices in place?
    6.4. How can you reinforce the desired results?
    6.5. Summary
7. Tools and Resources
Appendix: Bibliography of Studies Implementing Fall Prevention Practices
References

Authors

RAND Corporation
David A. Ganz, MD, PhD, VA Greater Los Angeles Healthcare System, University of California at Los Angeles, and RAND Corporation
Christina Huang, MPH, RAND Corporation
Debra Saliba, MD, MPH, VA Greater Los Angeles Healthcare System, UCLA/JH Borun Center for Gerontological Research, and RAND Corporation
Victoria Shier, MPA, RAND Corporation

Boston University School of Public Health
Dan Berlowitz, MD, MPH, Bedford VA Hospital and Boston University School of Public Health
Carol VanDeusen Lukas, EdD, VA Boston Healthcare System and Boston University School of Public Health

ECRI Institute
Kathryn Pelczarski, BS
Karen Schoelles, MD, SM
Linda C. Wallace, MSN, BSN
Patricia Neumann, RN, MS