This document outlines an evidence-based fall prevention project conducted by nursing students at Alvernia University. It includes background information on the problem of falls in hospitals, learning objectives, a PICO question, and a literature review. The literature review found that multicomponent fall prevention programs utilizing multiple nursing interventions tailored to individual patient needs are most effective at reducing inpatient falls compared to single interventions alone. Continuous re-evaluation of interventions is important to assess effectiveness and improve outcomes. Current practices at Good Samaritan Hospital for fall prevention are also described.

1. Fall Prevention
An Evidence-Based Practice Project
Alvernia University
Spring 2016
Timothy Espersen, SNALV
Emily DeCampo, SNALV
Briana Austin, SNALV
Amanda Bozzelli, SNALV

2. Learning Objectives
 Compare and contrast individual versus multi-component nursing
interventions to decrease inpatient falls.
 Discuss nursing interventions that can be implemented without a provider’s
order.
 Describe the nurse’s role in decreasing inpatient falls of hospitalized clients.
 Evaluate effective nursing interventions to help decrease inpatient fall rates.
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3. Background/Problem
 “Falls are associated with increased health care use, including increased
length of stay and higher rates of dis- charge from hospitals into long-
term care facilities. Even a fall that does not cause an injury can trigger
a fear of falling, anxiety, distress, depression, and reduced physical
activity." (Miake-Lye, Hempel, Ganz, & Shekelle, 2013)
 “Falls are a leading cause of nonfatal injuries and trauma-related
hospitalizations in the United States, and have been linked directly with
the quality of nursing care in the hospital setting. In this literature
review, multiple studies are summarized that found rounding decreased
falls per 1,000 patient days.” (Hicks, 2015)
 “Falls are a patient safety priority among hospital inpatients. The
creation of a Patient Safety Team engaged frontline staff in patient
safety and falls prevention. This intervention decreased the fall rate
from 1.90 to 0.69 falls per 1,000 occupied bed days.” (Christiansen, Feider,
Godlock 2016)
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4. Clinical Significance
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MONTH AVERAGE FALLS
PER MONTH
GOAL BASELINE
JULY 2015 2.5 1.8 3.35
AUGUST 2015 1.1 1.8 3.35
SEPTEMBER 2015 1.19 1.8 3.35
OCTOBER 2015 4.75 1.8 3.35
NOVEMBER 2015 2.3 1.8 3.35
DECEMBER 2015 3.79 1.8 3.35
Good Samaritan Hospital
Telemetry Unit- 3S
3S Unit: Inpatient Fall Rate

5. Clinical Significance
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MONTH FALLS PER 1000
PATIENTS
GOAL BASELINE STATE
OCTOBER 2015 2.5 1.8 2.11 1.8
NOVEMBER 2015 2.1 1.8 2.11 1.8
DECEMBER 2015 1.9 1.8 2.11 1.8
Good Samaritan Hospital
Hospital Wide Inpatient Fall Rate (falls per 1000 patient days)

6. PICO
 P= Adult and geriatric hospitalized population
 I= Individual nursing interventions
 C= A multicomponent fall prevention program
 O= Decreasing inpatient falls
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7. PICO Question
 In the adult and geriatric population, what is the effectiveness of individual
nursing interventions versus a multicomponent fall prevention program to
decrease inpatient hospital unit falls?
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8. Literature Reviewed
Search Engines Used
EBSCOhost- Health, CINAHL, OVID, PubMed, Cochrane Library, JBI
Date Range Used
2011-2016
Search Limiters
Not Pediatrics
Not Neonates/Infants
Not articles older than 2011
Keywords Used
fall prevention, fall prevention interventions, fall prevention prpgrams, nursing interventions,
nurse’s role, decreasing falls, hospitalized clients, adult clients, adult patients, geriatric clients,
geriatric patients, adult and geriatric population, inpatient falls, decreasing falls, decreasing
inpatient falls, fall risk, bed alarms, bed alarm use, patient education, staff education, nursing
involvement
Articles Reviewed
18 articles reviewed
8 articles selected for inclusion
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9. Literature Review: Levels of Evidence
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Level Of Evidence Number of Articles
found
Summary of Findings
Level I 5 Data found through review of multiple studies
reveals that a multi-intervention approach can
lead to decreased inpatient falls and help
prevent further complications of patients.
Level II 2 Individualized targeted multiple fall
interventions should be implemented in the
acute care setting in addition to fall prevention
strategies that are already in place
Level III 0 N/A
Level IV 1 There is some data that shows correlation
between the use of low-low beds and
decreasing inpatient falls. A randomized
controlled trial is required to give additional
evidence.

10. Fall Risk Safety
Letter-Good Samaritan Hospital
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0
-Letter presented to patients and their
families upon admission if patient is
found to be at a high risk for falls

11. Current Practice-
Fall Prevention Policy/Practice Change (February 2016)- Good
Samaritan Hospital
Effective immediately, if a patient “refuses” a part of the fall prevention protocol (including the use
of the BED ALARM), the following steps must be followed:
1.RN must educate the patient on the safety measures associated with intervention. If the patient still
refuses, the RN must communicate the refusal to the Charge Nurse
2.The Charge nurse must meet with the patient and explain to the patient the need for the safety
intervention. If the patient still refuses, the Charge Nurse must communicate the refusal to the NM
(nurse manage), ANM (assistant nurse manager), or Supervisor
3.The NM, ANM, or Supervisor must meet with the patient and explain the need for the safety
intervention. If the patient still refuses, a 1:1 sitter must be arranged to keep the patient safe.
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12. 1
2
Fall risk Interventions
- Special bracelet to alert staff of the patient being at a high risk for falls.
- A sign placed above the patients bed to encourage staff members to assist with the patients
safety
- Patients instructed to use they call light when they want to get out of bed
- Patients are asked to wear nonslip, footwear, and will be provided if needed
- Patients will be periodically checked on to provide assistance with toileting and positioning
- Keep some of the side rails up to prevent the patient from accidentally falling out of bed.
-Alarms may be used to assist with patients safety
-Patients will have a fall risk rating placed outside their door to alert staff of the level of
assistance that may be needed to ambulate
For patients identified as a high fall risk by the nurse, receives a Fall Risk Safety Letter regarding the
interventions that will be put into place to help prevent the patient from falling during the inpatient
stay.
Current Practice-
Fall Prevention Policy/Practice Change (February 2016)- Good Samaritan Hospital

13. Post Fall Assessment
Document- Good Samaritan
Hospital
- Form to be completed by the primary
nurse of a patient after an inpatient
fall
- Form helps to identify the possible
root cause of the fall and may be
able to help prevent future falls due
to the same cause

14. Summary of Evidence
 The use of low-low beds did decrease the rate of falls, but decreased the
level of injuries that occurred with the falls
 Patient education related to their disease process and their increased risk for
falls decreased the rate of falls
 Hourly rounding showed promising effects on decreasing patient fall rates
 Include interventions such as a toileting schedule, medication review, and a
post fall conference in a multicomponent fall prevention program
 Open communication and staff education have a positive influence in
decreasing falls
 Exercise interventions and vitamin D/calcium supplementation may show
reduction in the number of falls

15. Summary of Evidence- Cont…
 Single versus Multiple intervention fall prevention approaches
 The use of using only one fall prevention intervention has shown to help to
decrease inpatient falls, but as the literature suggests, multiple fall interventions
put into place based on the client have proved to be more effective.
 Data found through review of multiple studies reveals that a multi-intervention
approach can lead to decreased inpatient falls and help prevent further
complications of patients.

16. Integrating Evidence into Practice
 When implementing nursing interventions to prevent falls, a multi-fasciated
approach should be taken and should be individualized based on client need.
 Continue to monitor patients that are high fall risks to determine if more
interventions need to be applied and whether or not the initial interventions
are effective.

17. How to Integrate the Evidence Into
Practice
 Continue with previous fall prevention measures (bed/chair alarms, signs and
bracelets, 1:1 sitter, instructed to use call bell when patient wants to get out of
bed, wearing nonslip footwear, keeping side rails up)
 Add specific client education about how to client’s disease process makes them at
an increased risk to fall without assistance to increase the patient’s knowledge
about their risks and decrease patients ambulating out of bed without calling for
assistance
 Implement the use of low-low beds to decrease injuries during a fall
 Keep open communication with team members
 Provide a toileting schedule for patients whose bowel and bladder habits are
impaired by their disease process
 Review medications with patients when appropriate (patients without cognitive
impairment) to decrease their incidence of falls

18. Post-Activity Test
1. List 2-3 nursing interventions that contribute to decreasing
inpatient falls.
2. True or False: Multifaceted fall prevention programs do not show
any benefit versus single interventions in decreasing inpatient
falls.
3. True or False: Nursing interventions, like placing a patient on a
bed alarm, require and MD order.
4. Continuous Re-evaluation of nursing interventions that have been
implemented is necessary for determining effectiveness and
improving patient outcomes. (True or False?)
5. Explain the importance of decreasing inpatient falls, and what
effects falls can have on a patients hospital stay.
6. True or False: Continuous re-evaluation of RN interventions put
into place to prevent falls is key to preventing inpatient falls.
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19. Resources
 Ang, E., Mordiffi, S. Z., & Wong, H. B. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing
patient falls in an acute care hospital: A randomized controlled trial. Journal of Advanced Nursing, 67(9), 1984-1992.
Retrieved March, 2016.
 Barker, A., Kamar, J., Tyndall, T., & Hill, K. (2012). Reducing serious fall-related injuries in acute hospitals: Are low-low
beds a critical success factor? Journal of Advanced Nursing, 69(1), 112-121. Retrieved February, 2016.
 Choi, Y., Lawler, E., Boenecke, C. A., Ponatoski, E. R., & Zimring, C. M. (2011). Developing a multi-systemic fall
prevention model, incorporating the physical environment, the care process and technology: A systematic review. Journal
of Advanced Nursing, 67(12), 2501-2524. Retrieved February, 2016
 Darlene, H. (2015). Can rounding reduce patient falls in acute care? An integrative literature review. MEDSURG Nursing,
24(1), 51-55. Retrieved February 25, 2016.
 Graham, B. C. (2012). Examining Evidence-Based Interventions to Prevent Inpatient Falls. MEDSURG Nursing, 21(5),
267-270. Retrieved March 5, 2016.
 Godlock, G., Christiansen, M., & Feider, L. (2016). Implementation of an evidence-based patient safety team to prevent
falls in inpatient medical units. MEDSURG Nursing, 25(1), 17-23. Retrieved February 28, 16.
 Godlock, G., Christiansen, M., & Feider, L. (2016). Implementation of an evidence-based patient safety team to prevent
falls in inpatient medical units. MEDSURG Nursing, 25(1), 17-23. Retrieved February 28, 16.
 Guo, J., Tsai, Y., Liao, J., Tu, H., & Huang, C. (2013). Interventions to reduce the number of falls among older adults
with/without cognitive impairment: An exploratory meta-analysis. International Journal of Geriatric Psychiatry, 29(7),
661-669. Retrieved March, 2016
 Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient Fall Prevention Programs as a Patient
Safety Strategy. Annals of Internal Medicine,158(5; Part 2), 390-396. Retrieved February, 2016
 Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., . . . Miller, S. T. (2012). Effects of an
Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients. Annals of Internal Medicine Ann Intern
Med,157(10), 692-699. Retrieved February, 2016. 1
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