A government health agency reports that each year, somewhere between 700,000 and 1,000,000 people in the United States fall while they are in a hospital. Hospital falls may result in fractures, lacerations, internal bleeding, or even death. Falls with serious injuries are among the top 10 events reported to the Joint Commission’s Sentinel Event Database. Research and studies have concluded that many patient falls can be prevented through fall-prevention procedures and protocols.

The goal is to assess a patient’s underlying fall risk factors and then determine what steps need to be taken to prevent a fall from occurring. Many hospitals have undertaken a fall-prevention program that includes initial risk assessment, changes in hospital environment, and specific steps that are tailored to each patient’s particular risk.

In terms of fall risk assessment, the key is to identify those who are at risk, assess the specific risk factors, and design interventions such as positive actions to modify, and compensate for, risk factors that are specific to that patient. Many hospitals use published criteria in this process, such as the Morse Fall Scale or Hendrich II Fall Risk Model. These take into account the patient’s age, gender, cognitive status, and level of function.

The most common factors contributing to hospital falls are inadequate assessment, communication failures, not following protocols and safety practices in place or developed for a particular patient, inadequate staff orientation or supervision, inadequate staffing, and problems in physical layout and orientation.

One common fall incident is a patient trying to get out of bed and falling. There are interventions designed to avoid this, including bed rails and alarms that sound when a patient is leaving the bed. Unfortunately, studies have shown that bed rails often increase the risk of severe injury, because patients will try to climb over the rails. Alarms are not effective, because by the time they sound the patient may already have fallen. The use of restraints has been discouraged because it can cause emotional distress and panic in patients. In some hospitals, patients with a high-risk assessment for falls from bed must be assigned a “sitter” who can prevent this from happening.

Other fall incidents involve a patient who is helped to a bathroom, but then left alone while using the bathroom. Arising from the commode may cause a fall in blood pressure and dizziness. This is a difficult risk to avoid if the patient is otherwise functioning and does not want to use a bedside commode.

Although the goal of the many fall incident studies is to avoid such falls entirely, this is unlikely to be achieved. But even a modest reduction in fall incidents can mean a huge decrease in resultant injury and death.