Reducing Patient Falls: Safety Strategies in Hospital Care

Introduction

Patient safety should be the top priority in any healthcare organization where quality care is provided (Ward et al., 2019). Having a safety culture is therefore essential, and achieving buy-in among workers is a must. This paper addresses patient falls as a patient-safety issue. It examines the way an organization with which the author is familiar addresses the issue, comparing current practice against the concepts, principles, and practices that contribute to quality improvement and patient safety. It then considers the legal and ethical consequences of not addressing the issue, discusses recommended evidence-based interventions with particular attention to technology, and identifies strategies to overcome organizational barriers to change.

Understanding the Patient-Safety Issue of Falls

Patient falls are a safety issue common in this author's healthcare organization—a Midwestern hospital in the United States, specifically in the inpatient setting. Because hospitals often fail to implement best practices for reducing patient falls, the problem is an all-too-common one across all hospitals (Melin, 2018). However, as Khalifa (2019) points out, falls can be prevented with the implementation of the right strategies.

Core Concepts, Principles, and Current Practices

The goal of patient safety with respect to falls is to prevent the patient from coming to additional harm while receiving inpatient care. However, a patient's desire for mobility should also be respected—otherwise hospitals would routinely immobilize patients by restraining them to their beds. The main concept to be applied in this area is to ensure that the patient is neither demoralized by fear or unnecessary restriction nor made vulnerable to accidental falls that could have been prevented.

In the author's healthcare organization, the concept of falls is well understood: nurses know what it is and why it is a problem. They understand the goal of falls prevention, and they understand the risk to patients that comes both from neglecting them and from restricting them out of fear. The concept of falls and fall prevention is, however, not always foremost in the mind of a busy nurse.

Patient autonomy is the core principle to remember when preventing patient falls. Additionally, the principle of non-maleficence—"do no harm"—is central to the issue. Even as hospital staff should ensure patient autonomy, staff must keep in mind that they cannot allow a patient at risk of falling to navigate a cluttered environment strewn with obstacles. Staff must allow the patient to have access to mobility, but must take precautions to ensure that the environment is safe for the patient to navigate with proper assistance.

Nurses in the author's healthcare organization generally respect the principles of autonomy and non-maleficence. However, these principles are not always foremost in mind and can sometimes be misapplied. It is important that nurses understand these principles and how they are best applied in terms of preventing patient falls.

The practices involved in preventing falls include: (1) familiarizing the patient with the environment; (2) familiarizing the patient with call-light usage; (3) ensuring the call light is easily within reach; (4) ensuring the patient's personal belongings are within safe reaching distance; and (5) ensuring that steady supports are available for the patient to use. Other practices and strategies recommended by Khalifa (2019) include educating both patient and staff about what causes falls and what helps prevent them; exercising with patients when possible so that they are flexible and better able to maintain balance while walking; keeping the environment free from obstructions; and utilizing information technology—such as call lights or cell phones—to call for assistance and prevent a patient from taking unnecessary steps without proper support.

In this author's hospital, falls prevention practices and strategies are known but not always adhered to or implemented, for a variety of reasons. One factor is staff burnout, and another is alarm fatigue. Alarm fatigue is a consistent problem that prevents nurses from responding to every call light or alarm in a timely manner. A lack of communication among nurses is also a problem. Sometimes a difficult working relationship among nurses on staff during a particular shift causes them to avoid communicating, and in neglecting to communicate effectively, they put patients at risk who might otherwise be properly assisted.

Conclusion

Falls prevention is a challenge in most hospitals, including the inpatient care setting of this author's hospital. There is no single standard practice of care that applies universally. Falls prevention strategies are inherently subjective and depend on the goodwill and communication of nursing staff. That said, practical steps can be taken to remove obstacles and ensure sufficient attention is given to high-risk patients. Simple measures—such as making sure the call light is within reach or that personal items are safely accessible—can make a meaningful difference. Nurse communication is essential, and the use of cell phones to quickly call for support can help. "No Pass Zone" etiquette can be practiced even in environments where alarm fatigue is prevalent: if a nurse sees a call light, the response should be immediate regardless of patient assignment. Ensuring environments are free from obstacles and properly lit is another sound practice, and employing technology such as exergaming or virtual training can help both patients and nurses better understand fall risks—while upholding the principle of patient autonomy and adhering to the principle of non-maleficence.

References

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