Falls are a frequently reported clinical incident in hospitals around the world, including in WA., Falls continue to be the most commonly reported critical incident category across all severities of patient harm.The hospital setting is associated with an increased risk of falling among older people due to additional risk factors from both illness and a variety of unfamiliar and complex environmental hazards.
Hospital setting can severely affect a patient’s capacity to:
- judge and manage their own falls risk.
- remember what staff have discussed with them about their falls risk and how to manage this in hospital.
Falls frequently contribute to an increase in length of stay, use of health resources and rates of discharge to a nursing home.
While the body of knowledge regarding the risks of falls and how to reduce these risks is continually growing, one key message prevails: multifactorial, multidisciplinary approaches are best in the hospital setting.
A best practice approach for preventing falls in hospitals includes:
- multifactorial falls risk assessment
- the implementation of standard falls prevention strategies (minimum interventions)
- implementation of individualised interventions to address risks which are regularly monitored and reviewed.
Assessment for falls risk
Risk factors for falls increase an individual’s likelihood of falling. Falls result from a combination of intrinsic and extrinsic risk factors. The presence of multiple risk factors increases the likelihood and severity of a fall.
Understanding an individual’s beliefs, attitudes and priorities about falls and their management is crucial to the success of interventions to prevent and manage falls.
There are a wide range of risk factors for falls including intrinsic and extrinsic factors. 66% of all falls were categorised as unwitnessed and were most frequently associated with the patient walking or attempting to toilet or sit/stand.
A person at any age can fall, but older adults are more at risk of experiencing falls and fall related injuries. This increased risk is due to various age-related changes including physical inactivity, decreased muscle strength, sensory loss and impaired cognitive status.
Health conditions can also play a significant role in falls risks including a history of falls and chronic medical condition/s effecting balance and mobility.
There are other intrinsic factors that contribute to an increased risk of falls such as problems with nutrition, feet or footwear, clothing, and walking aids.
Some inpatient groups have fall risk profiles which differ from adult patients in the general population. More information can be found here.
Environmental factors also play a key role. These include slippery or uneven surfaces, clutter, poor lighting, step hazards, unsafe rails, and loose mats.