- The document reviews research literature on fall prevention programs in acute care settings. - Four meta-analyses and randomized controlled trials found that multicomponent fall prevention programs, including risk assessment, education, and post-fall evaluations, can reduce falls by up to 30%. - Studies also found that implementing a falls safety champion, in addition to multifactorial interventions, was associated with reductions in injurious falls by 58% and total falls by 27%, resulting in estimated savings of $776,064 and $450,000 annually.

1. RESEARCH LITERATURE REVIEW
•Four meta-analysis (19 studies) universally found
multicomponent fall prevention programs, including
use of a fall-risk assessment tool, patient and staff
education, and post fall evaluations, reduce risk for
falls by as much as 30% (Miake-Lye et al., 2013).
• Four randomized controlled trials (n= 6,478)
found a 31% decrease in falls when multifactorial
interventions were implemented. Fall incidents
were compared before and after interventions, rate
ratio = 0.69, 95% CI (Miake-Lye et al., 2013).
•Trepanier and Hilsenick (2014) found that
precautionary care including a falls safety
champion reduced the occurrence of injurious falls
by 58.3% (n=36). Corresponding cost savings was
an estimated $776,064.
•A quality improvement initiative conducted on eight
nursing units and four hospitals using a
multifactorial bundle which included a falls safety
champion. Pre-initiative falls = 146 and post-
initiative falls = 110 with estimated savings of
$450,000 annually (Spiva & Hart, 2012).
CHANGE PROCESS
Use of a Falls Safety Champion to Reduce the Prevalence of
Falls in Acute Care Settings
PACE University, College of Health Professions, Lienhard School of Nursing
PICO: For geriatric patients ages 65 and older with a score greater than or equal to 45 on the Morse
Fall Scale, can the implementation of a unit based nurse falls safety champion on a medical surgical
unit in an urban hospital serving active duty and retired military personnel, in comparison with existing
fall measures, reduce the prevalence of falls within this population?
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•The desired outcome is a reduction in the
number of falls for geriatric patients in the
experimental group as compared to the control
group.
•The incidence of falls on the medical surgical
unit will be monitored over the course of 1,000
patient days.
•MFS scores will be calculated by nurses at the
time of admission to the floor and reports on the
number of hospital falls will be conducted on a
monthly basis.
•Authors propose statistical analysis involving
rate ratios to determine
the effectiveness of the
FSS. Researchers will
use a rate ratio and 95%
confidence interval (CI)
to compare the rate of
falls (e.g. falls per person
year) between
experimental and control
groups.
REFERENCES
Agency for Healthcare Research and Quality (2012). Prevention of falls (acute care). Health care protocol.
Retrieved from http://www.guideline.gov/content.aspx?id=36906&search=morse
Level of Evidence: Evidence-based Practice Guideline
Agency for Healthcare Research and Quality (2013). Tool 3H: Morse fall scale for identifying fall risk factors.
Retrieved from http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtktool3h.html
Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., . . . Shorr, R. I. (2013). Falls
among adult patients hospitalized in the united states: Prevalence and trends. Journal of Patient
Safety, 9(1), 13–17. doi:10.1097/PTS.0b013e3182699b64
Level of Evidence: Systematic Review
Centers for Disease Control and Prevention (CDC). (2015, September). Costs of falls among older adults.
Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
Centers for Medicare & Medicaid Services (CMS). (2015, August). Hospital-acquired conditions. Retrieved
from https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitalacqcond/hospital-
acquired_conditions.html
Degelau, J., Belz, M., Bungum, L., Flavin, P. L., Harper, C., Leys, K., . . . Webb, B. (2012).
Prevention of falls (acute care). Health care protocol. Agency for
Healthcare and Research Quality (AHRQ). Bloomington (MN): Institute for Clinical Systems Improvement
(ICSI): Retrieved from http://www.guideline.gov/content.aspx?id=36906&search=morse+fall+scale
Level of Evidence: Evidence-based Practice Guideline
Kruse, K. (2015). The ROI of employee engagement: Engagement springs from growth, recognition and
trust. Aspen Publishers, Inc. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=edsgao&AN=edsgcl.408510805&site=eds-live&scope=site
Level of Evidence: Evidence from Systematic Reviews of Descriptive and Qualitative Studies
Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a
patient Safety strategy: A systematic review. Ann Intern Med., 158, 390-396.
Level of Evidence: Systematic Review
Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: The older population in the United States.
Current population reports. Retrieved from: https://www.census.gov/prod/2014pubs/p25-1140.pdf
Spiva, L. & Hart, P. (2012). Evidence-based intervention for preventing falls in acute care hospitals. Retrieved
from http://new.medline.com/media/mkt/pdf/White-Paper-Evidence-Based-Interventions-for- Preventing-
Falls-Acute- Care-Hospitals.pdf
Level of Evidence: Evidence from Single Descriptive or Qualitative Studies
Trepanier, S. & Hilsenbeck, J. (2014). A hospital system approach at decreasing falls with injuries and cost.
Nursing Economics, 32(3), 135-41. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25137810
Level of Evidence: Controlled Trails without Randomization
Yu, S. Y., Ko, I. S., Lee, S. M., Park, Y. W., & Lee, C. (2011). A unit-coordinator system: An effective method
of reducing inappropriate hospital stays. International Nursing Review, 58(1), 96-102. doi:10.1111/j.1466-
7657.2010.00850.x
Level of Evidence: Randomized Control Trial
• Target sample population is geriatric patients
ages 65 and older on a medical surgical unit
with a Morse Fall Scale score ≥45.
• The control group of the target population will
be assessed for fall risk using the MFS and
experience usual precautionary care regarding
fall prevention.
• The experimental group of the sample
population will receive the same assessment
and precautionary care. However, their
multifactorial intervention will include the
addition of a Falls Safety Champion nurse.
• Evaluation of this intervention
will be conducted to
determine if this measure
can enhance the bundle
intervention currently in
place.
• Authors propose the implementation of a falls
safety champion to enhance the multifactorial
intervention already in place in an urban
hospital serving active duty and retired military
personnel.
• Following approval by the the nursing
education department and nursing
administration, this intervention will be
introduced to the staff through a three part
inservice and volunteers for the role will be
sought after.
• The FSC nurse should be selected based on
merit and experience. Yu et al. (2011) states,
the selected falls champion should
demonstrate continued dedication and
commitment to its cause.
• To attract candidates to the falls safety
champion role the nursing educator and
nursing administration can use the following
incentives:
1) Establish the falls safety
champion as a symbol of
excellence in service and
patient care.
2) Gold pin identification.
3) Recognize selected champion in
organization newsletter and
website.
4) $2.00 pay differential for the selected RN.
BACKGROUND PROPOSED PRACTICE CHANGE
Beny Babu
Suraiya Chowdhury
Kaitlyn Curran
Steven Jacques
Kelvin Masilanani
Claudine Pearson
MAJOR RECOMMENDATIONS
• A falls safety champion is a unique component
of multifactorial interventions used to reduce the
incidence of falls in acute care settings (Agency
for Healthcare Research and Quality, 2012).
• Prevalence: In hospitals, the prevalence of falls
ranges from 1.3-8.9 falls per 1,000 patient days.
Over 700,000 patients are hospitalized annually
because of fall related injuries, most often due
to a head injury or hip fracture (Centers for
Disease Control and Prevention, 2015).
• Morbidity/Mortality: Fall related injuries in clients
≥65 are often linked to alterations in mental
status, impaired gait, need for ambulatory aids,
and polypharmacy. Mortality rates associated
with falls in the acute care settings are less than
one percent (approximately 11,000 fatal
falls/year).
• Costs: Falls add $34 billion dollars to health
care costs each year (CDC, 2015)
• Nursing implications: The population of adults
age ≥65 is expected to grow from 43.1 million to
83.7 million by 2020 (Ortman et al., 2014);
hence the number of falls/ fall-related expenses
is projected to increase as well. Nurses are at
the forefront of patient care and must work to
reduce the number of falls seen in acute care
settings.
SEARCH STRATEGY
• Databases used included:
1) PubMed
2) CINAHL
3) Proquest
4) Cochrane Library
5) CDC
6) AHRQ
Keywords: Falls safety champion, expert unit
coordinator, fall risks, older adult, morse fall scale,
accidental falls, hospital fall prevention.
Delimitations: publication date of 2010 and after;
studies where a personal care assistant was
selected as a safety champion were not used.
Studies identified: 12 articles- two systematic
reviews, two evidence-based practice guidelines,
and one randomized controlled trial were chosen
EVALUATION
EBP recommendations Relation to PICO
Question/ PIP
A registered nurse should be designated as
the unit falls safety champion (FSC) (Spiva &
Hart, 2012).
Screen only nurses for the
position of a falls safety
champion and select an RN for
each unit based on merit and
excellent standards of care.
Use the Morse Fall Scale (MFS) to assess
possible fall risk factors including impaired
gait, need for ambulatory aids etc. (Agency
for Healthcare Research and Quality, 2013)
Identify geriatric patients at risk
for falls as those with a score
≥45 on the MFS.
The role of the FSC is to facilitate
communication among the IDT and lead post-
fall huddles to assess what aspects lead to
the fall and what can be learned from the
incident (Degelau et al., 2012)
The falls champion advocates for patient
safety by educating patients and staff about
the principles of fall prevention while
reinforcing hospital policy (Deglau et al.,
2012). Enhancing communication and
education regarding fall prevention lowers the
number of hospital falls.
Implement the nurse unit
champion as part of a bundle
intervention to reduce the
incidence of falls in acute care
settings