Developing and implementing a fall prevention algorithm to improve patient safety: a quality improvement project

Abstract

Statement of the problem: Approximately one million falls occur in U.S. hospitals every year. Inpatient falls are the leading cause of preventable hospital-acquired adverse events, accounting for 70% of all accidents reported by hospitals. Inpatient falls have significant impact on healthcare costs, due to increased patient morbidity, mortality and limited reimbursement. Fall prevention clinical practice guidelines lack consensus regarding effective fall prevention interventions. Inpatient falls continue to be a major concern across the globe despite extensive prevention efforts. Methods: A scoping literature review was conducted to explore the body of evidence available regarding known causes, impact, fall prevention strategies and interventions. A database search was conducted across multiple databases using keyword terms related to inpatient falls. Results were screened for inclusion eligibility based on several factors to produce a current, comprehensive, evidence-based review of the known literature. Results: The evidence within the literature is extensive regarding known causes and impacts but variable regarding effective solutions and prevention strategies. Inpatient falls are multifactorial, complex and often caused by non-modifiable risk factors. Implementation, interventions and risk assessment tools vary dramatically across and within organizations, making comparison of research findings difficult. Clinical practice guidelines offer vague and varying recommendations for fall prevention programs. There is emerging evidence that multifactorial approaches that incorporate evidence-based risk assessment tools, risk stratification and tailored interventions are the most effective strategy currently being utilized. Conclusions: Inpatient falls continue to be a concern due to the dramatic impact for both patients and organizations. The lack of consensus in evidence and guidance perpetuates this complex problem. Multifactorial approach fall prevention programs have emerged as the most effective strategy at reducing and preventing inpatient falls. Quality improvement projects which utilize multifactorial approaches are supported by the evidence within the literature as a cost- effective strategy to prevent and reduce inpatient falls.