Study Finds Tool Kit Prevents Falls

The use of a patient-tailored fall prevention program has reduced the number of older patients who experience falls in hospitals, according to a study conducted by Harvard Medical School instructor Patricia C. Dykes.

Dykes and her colleagues developed a “fall prevention tool kit” that includes a fall risk assessment, patient-specific prevention plan, educational handouts for patients, and posters hung over patients’ beds that detail why they are at risk of falling.

At four urban U.S. hospitals, the researchers compared the fall rates of units that used the usual fall prevention program and those that implemented the tool kit.

The study, published Wednesday in the Journal of the American Medical Association, found that 67 out of 5,160 patients in units using the tool kit had falls—compared to the 87 out of 5,104 in the control units.

Hospitalized patients are at a higher risk of falling due to the unfamiliar environment, the effects of medication, and their states of health. Falling not only has physical consequences—such as fractures, head injuries, and even death—but is also costly for patients, their families, and the health care system, according to Dykes, who also works for Partners HealthCare.

The elderly population is particularly at risk of falling: one in every three adults who are 65 and older falls each year, according to the Centers for Disease Control and Prevention.

The Morse fall scale is currently used in acute care settings to assess a patient’s likelihood of falling. If the scale concludes that a patient is at high risk, a “High Risk for Fall” sign is posted by the individual’s bed—without providing information on why the patient is at risk and the kinds of behavior that should be avoided.

But Dykes’ project rethinks this approach: “Instead of having a blanket of intervention across all patients, we looked at what places a patient at risk individually,” she said.

Dykes said she hopes hospitals will implement the fall prevention tool kit, or at least recognize that the plan of care currently in place to prevent falls should be tailored to fit a patient’s specific risks.

Further research is needed to determine if the tool kit can reduce repeated falls over time and to develop a set of interventions to prevent fall-related injuries.