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Informatics Project: Fall Prevention in Healthcare

Lauren Carter

Delaware Technical Community College

NUR410- Nursing Informatics

Professor St John

November 20, 2022

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Falls in Healthcare

       Patient falls are among the most common but preventable incidents in acute

healthcare settings. Approximately 30% of inpatient falls result in various injuries and are
typically referred to nursing care (Dykes & Hurley, 2021). A fall may result in fractures,

lacerations, or internal bleeding, leading to increased healthcare stay, setback to recovery, and

poorer prognosis. Research shows that close to one-third of falls can be prevented. Fall

prevention involves managing a patient's underlying fall risk factors and optimizing the

hospital's physical design and environment. It is crucial to prevent falls to maintain patient in

the most optimal care and keep patients safe. The most common risk factors for falls are a

history of falling, gait instability, lower limb weakness, need for toileting, agitation,

confusion, impaired judgment, and medications like sedatives (Dykes & Hurley, 2021). It is

crucial for each hospital facility to have a fall prevention plan in place to decrease the

problem of falls.

Fall Prevention Strategies

Since fall are a predominant occurrence in healthcare, most facilities have fall risk

screening tools and fall risk plans in place to decrease the likelihood of falls. The most

common fall risk screening tool is called the Morse Fall Scale (MFS). This scale addresses six

common predictors of falls when used properly. These are based on the history of falls

immediate or in the last three months, secondary diagnosis, ambulatory aid, IV/heparin lock,

gait/transferring, and mental status (Dykes & Hurley, 2021). Regarding informatics, the

Morse Fall Scale typically populates as a task on the EMR or activities list of things to do for

a nurse for computer charting to see how much of a risk a patient is at for falling (Jung et al.,

2019). Most facilities require nurses to fill out a Morse Fall Scale for each patient. This tool

can identify risk factors for falls in hospitalized patients. The total score may be used to

predict future falls, but it is more important to identify risk factors using the scale and then

plan care to address those risk factors. It is also crucial for healthcare professionals to read the
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EMR for progress notes, H&P, and orders to see if there is any documentation of falls or if a

patient is a fall risk (Jung et al., 2019).

Another way informatics is related to reducing the risk of falls is the use of smart

technology such as bed and chair alarms that go off when the patient is trying to get up (Jung

et al., 2019). This informatic rings in the patient’s room, by the patient’s room number, and at

the nurse’s station where the central monitor is. The invention of alarms on the Hill-Rom beds

with different settings has greatly helped in decreasing the number of hospital falls. Call bells

are also a very important aspect which is linked to a computer program to notify healthcare

providers when a patient needs something. For extremely confused patients that consistently

get out of bed or are suicide precautions there are 1:1 human sitter available for their safety.

Unfortunately, sometimes due to the lack of staffing these individuals do not have the

opportunity to have this intervention to help prevent falls and keep the patient safe.

Additionally, informatics can be used for patient education by making pamphlets, signs,

PDF’s, posters, and more to hang around the facility and give to patients to promote the

prevention of falls and educate techniques to ask for help and not get out of bed or the chair

without assistance (Jung et al., 2019).

It is the job of healthcare providers to do hourly rounding to make sure all the needs of

patients are met. This is an important time to offer patients to use the bathroom, provide a

snack or activity, and make sure the patient has everything in reach and is aware of their

surroundings. It is also essential for healthcare providers to ensure that patients are wearing

their nonskid socks or proper footwear for when patient get out of bed, have a fall risk band

on, all ambulatory devices are within reach, and the bed is in the lowest position with wheels

locked. Although most hospital facilities have a fall risk plan implemented there is always

room for change and growth to decrease the likelihood of falls in the hospital setting. The new

strategies are crucial and truly assist healthcare providers in preventing falls in healthcare.
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Fall Prevention Workflow:
New Strategies
*Assessment for Falls:

 Morse Fall (>25)

 Communication Deficits
 History of Falls
Patient Admitted to Hospital
 Weakness
 Sensation Deficits
 Confusion
 Impulsiveness
*Complete Fall Risk Assessment

Is the patient a fall risk?

 Patient independent
Yes No  No bed/chair alarm needed
 Patient safe to maneuver around

Prevention Strategies:

 Bed/Chair alarm
 Bed/Chair always locked
 Non-skid socks / Safe footwear
 3 out of 4 bed rails up
 Ambulatory devices in reach
 Gait belt in room
 Toileting schedule Q2hr
 Hourly rounding
 1:1 Human Sitter
 Encourage visitors to keep patient company
 Review medications
 PT/OT
 Patient education
 Keep patients busy when applicable: coloring, folding items, games, tv, etc.
 Familiarize patient with environment (including equipment such as IV pole)
 Maintain call bell within reach
 Pain management
 Adequate lighting
 Staff must assist patient when up
 Fall band on

Decrease in Falls
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New Fall Prevention Strategies

Change in healthcare is inevitable. Every day there is new research, evidence-based

practice, policies, procedures, and more to promote the best quality of care to patients and keep

them safe. Therefore, there are new strategies that I believe can be implemented for the safety of

our patients to reduce the number of falls that occur in the healthcare setting. There are four new

strategies that come to mind that could be implemented in the healthcare facility that I am

currently employed. These strategies are the use of telecameras, patients at risk of falls looking

uniform, visual cues on patients’ doors, and the development of risk management systems. These

four new strategies would significantly help to decrease the number of falls in the hospital.

Telecameras

A new and upcoming informatics design to assist in the prevention of fall is the

telecamera. The telecamera is the best invention and is very cost-effective for hospitals

especially when these healthcare systems are already short staffed. Telecameras can be used in

place of 1:1 human sitter that are used for extreme confusion, impulsiveness, and fall prevention

which are unfortunately so hard to get due to staffing anyway (Jung et al., 2019). Therefore, the

use of telecameras can be put to great use to keep patients safe. The telecamera is a technological

invention that sits in the patient’s room (Jung et al., 2019). The telecamera is on a stick

essentially that can rotate around the room to directly watch a patient every move. Most of the

telecameras that are used are controlled by humans in a telecamera room which watches the

screens of the patients being monitored. The individuals behind the telecameras in the screen

monitoring room can manually alarm and/or speak to the patient. If the patient does not listen to

the telecamera when the individuals are speaking, then a loud alarm goes off to make all other

healthcare professionals aware. The alarm is unique and linked to a patient getting out of bed or
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the chair (Jung et al., 2019). The telecamera can closely monitor all motion even in the dark.

The individuals behind the camera can also call the nurses station when a patient is doing

something they are supposed to like messing with any lines, devices, or tubes. Informatics seen

with the telecamera a huge improvement in aiding in the reduction of falls.

Uniform and Visual Cues

Another new strategy that I believe would be extremely useful in the healthcare setting of

my current employment is implementing that all fall risk patients look uniform and place a visual

que outside the door of those who are at risk of falls. It is crucial to make all patients that are at

risk for falls look uniform so that all healthcare providers are early able to identify them even if

they aren’t in the current care of these individuals (Fall, 2022). If all healthcare providers are

aware, then anyone can help at any time to assist in preventing falls. All patients are required to

wear a hospital gown and if they qualify as a fall risk under the Morse Falls risk screening then

they must have yellow fall risk bracelet on. However, to make the patients that are fall risk stand

out a little more, I believe that all these patents should wear the same-colored non-skid sock,

specifically red. This can be the new sign that patients are a fall risk and would be easily

identified if patients are wearing socks. This is an easy cost-effective technique as the hospital

already must purchase nonskid socks, therefore they can take away one of the current colors and

add the color red for an easy identifier of those who are at risk for falls (Fall,2022). Although

informatics is not truly used in the idea of making all patients uniform, the next idea of placing

visual cues on patients’ doors is when informatics can come into play (Fall, 2022). Another way

to easily identify a patient that is a fall risk is to place a visual cue on the door to alert healthcare

providers that a patient is at risk for a fall. A simple symbol of a patient falling or a code letter

like “F” could be used as the visual cue. These symbols can easily be made with informatics on a
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online database such as Microsoft word or publisher. This technique would not cost the hospital

hardly anything as all these platforms such as Microsoft is already purchased. The only thing that

may have to be done is laminating of the symbols. These visual cues are an easy implementation

to making healthcare providers aware of patient that are at risk of falling.

Risk Management System

The last technique that I believe would benefit my current place of employment is

creating a risk management system (Fall, 2022). Currently, my place of employment takes note

of patients that fall and writes a safety tracking tool so that all falls are documented. However, I

believe my place of employment should take it to the next level by creating a risk management

system which does not only document the falls but does follow-up and meets with a team to

discuss the incident to see what could have been done to have prevented the fall (Fall, 2022). A

risk management system can help care providers document previous fall history and assess this

information to define departmental areas of improvement. Rounding tools and incident reporting

software make it simple for staff members to proactively address patient needs and

environmental concerns and correct any deficiencies prior to a fall occurring (Fall, 2022). I think

it would be beneficial to have a fall prevention team where each unit has designated team

members to focus on fall prevention and keep track of the hospital data regarding falls. A risk

management system would be cost-effective to the hospital. Informatics would have a crucial

role in the implementation of a risk management system as all the data that is collected would be

put on a database to see the trends which will help to improve the healthcare system with

preventing future falls.

Conclusion
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Overall, it is crucial to prevent falls by completing a fall risk assessment on the EMR,

developing a personalized plan for that individual, and making sure the plan is consistently

implemented and this could not be successfully done without informatics. The new strategies of

using telecameras, making patients at risk of falls looking uniform, visual cues on patients’

doors, and the development of risk management systems can all be used to help improve

healthcare with preventing hospital falls. Technology has provided a means to fall reduction for

healthcare organizations. These new strategies, specifically the telecamera, has the potential to

become a safe and effective intervention for patients and a method for healthcare organizations

to increase productivity while increasing patient safety and preventing falls.

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Fall Prevention Workflow:
New Strategies
*Assessment for Falls:

 Morse Fall (>25)

 Communication Deficits
 History of Falls
Patient Admitted to Hospital
 Weakness
 Sensation Deficits
 Confusion
 Impulsiveness
*Complete Fall Risk Assessment

Is the patient a fall risk?

 Patient independent
Yes No  No bed/chair alarm needed
 Patient safe to maneuver around

Prevention Strategies:

 Bed/Chair alarm
 Bed/Chair always locked
 Non-skid socks / Safe footwear
 3 out of 4 bed rails up
 Ambulatory devices in reach
 Gait belt in room
 Toileting schedule Q2hr
 Hourly rounding
 1:1 Human Sitter
 Encourage visitors to keep patient company
 Review medications
 PT/OT
 Patient education
 Keep patients busy when applicable: coloring, folding items, games, tv, etc.
 Familiarize patient with environment (including equipment such as IV pole)
 Maintain call bell within reach
 Pain management
 Adequate lighting
 Staff must assist patient when up
 Fall band on

New Strategies:

 Telecamera
Decrease in Falls
 All fall risk patients wear same color socks
 Visual cues posted on patients’ doors
 Risk Management Systems
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Fall Prevention Policy

Purpose: To address fall prevention and management

Scope: To include inpatient, outpatient, and visitor fall prevention and management in the

healthcare setting to avoid these incidents from occurring in healthcare facilities

Definition:

 Fall: a sudden, unintentional descent, with or without injury to the patient, that results in

the patient coming to rest on the floor, on or against some other surface, on another

person, or on an object.

 Examples:

 When a patient rolls off a low bed onto a mat or is found on a surface

where you would not expect to find a patient, this is considered a fall.

 If a patient who is attempting to stand or sit falls back onto a bed, chair, or

commode, this is only considered a fall if the patient is injured.

Policy:

Healthcare facilities should create a safe physical environment for the community and healthcare

patients, both inpatient and outpatient. When identified as a risk for falls fall interventions

appropriate to the care setting should be implemented to reduce the incidence of falls and to

reduce the risk of harm resulting from falls. All data must be reviewed regularly with

interdisciplinary team.

Procedure:

I. Assessment

i. On admission, the nurse is to assess a patient’s risk for falling utilizing the Morse

Fall Risk Assessment in the medical record.

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ii. Interventions should be implemented based on the “Fall Prevention Guidelines”

which are in Appendix A of this policy.

iii. Family/Caregiver involvement in fall prevention may be utilized when

appropriate.

Morse Fall Risk Assessment Scoring

History of Falls: Immediate or within 3 Yes: 25 / No: 0

months
Presence of Secondary Diagnosis Yes: 15 / No: 0

Use of Ambulatory Aid Furniture: 30

Crutches, Cane, Walker: 15
None, Bedrest, Wheelchair: 0
IV or Heparin Lock Fall Risk Yes: 20 / No: 0

Gait weak or Impaired Fall Risk Impaired: 20

Weak: 10
Normal, Bedrest, Immobile: 0
Mental Status Fall Risk Forgot limitations: 15
Oriented to Own Ability: 0

II. Reassessment

i. The nurse should reassess the patient’s fall risk every 12-hour shift and as needed

as condition warrants, such as change in mental status or within 24 hours post-

procedure.

III. Interventions/Precautions

i. Interventions and education should be implemented as necessary based on fall

risk assessment. Refer to Appendix A for “Fall Prevention Guidelines.”

ii. Based on nursing judgement, precautions and interventions may be increased.

iii. Beds equipped with safety features should be utilized and toileting schedules must

be maintained.

IV. Education
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i. It is crucial to educate patients, family members, caregivers, staff members and

others to reduce the risk of falling in the healthcare setting.

ii. Provide handouts, pamphlets, videos, training, and more to aid in educating about

fall prevention.

V. Mandatories for all Employees

i. Staff Education: All team members of the healthcare facility- clinical and

nonclinical- are to receive education about fall prevention and management upon

hire and annually

ii. Fall Monitoring: Fall occurrence data is reviewed as part of the Risk

Management data and reviewed with the Fall Prevention Team. The data collected

allows for plans to be established to reduce falls and injuries associated with falls.

Each healthcare facility should have a Fall Prevention Team.

iii. Interventions: Staff should keep walkways free from clutter; aid any patients and

visitors that ask or in their clinical judgment require assistance with ambulating,

toileting, or assistance up or down from exam areas or any other assistance. Staff

should also provide wheelchair assistance for any patient that requests it or in

their clinical judgment may need assistance, including to and from vehicles.

VI. Procedure to Follow if a Dall Occurs

i. Remain calm, call for help, and stay with the patient until additional assistance
arrives.
ii. Assess the patient for airway, breathing, circulation, level of consciousness, and
extent of injuries including spinal injuries, if any.
iii. Assess the patient and initiate appropriate interventions for suspected injuries.
Special Consideration for injury potential should be utilized in patients with
bleeding risk, advanced age (85 or >), history of falls.
iv. Notify the Nursing Supervisor at time of fall.
v. Notify physician at time of fall.
vi. Notify family as soon as practicable of fall.
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vii. Assure completion of physician ordered treatments and diagnostic studies.

viii. Document the Post Fall Assessment, the Plan of Care, Falls Education in the
medical record.
ix. Conduct a debriefing after each fall with any members present at the time of the
fall and/or nursing staff assigned to caring for the patient and the charge nurse to
determine what could have been done differently to prevent future similar falls
and use this information to educate staff, patient, and disseminate lessons learned
to staff.
x. Reassess the Fall Score, document in the medical record, apply appropriate
interventions, and debrief with the Fall Prevention and Risk Management Teams.

Appendix A: Guidelines for Fall Preventions

Interventions Low Risk for Medium Risk for High Risk for Fall
Fall (0-24) Fall (25-45) (>45)


Educate Patient and Family:
Fall Risk
√ √ √
 Purposeful Rounding
 White Boards Updated
Keeps frequently used items within
reach
√ √ √
Maintain adequate lighting √ √ √
Maintain area free of clutter √ √ √
Use non-skid footwear √ √ √
Maintain bed in lowest position with
wheels locked
√ √ √
Utilize bed/chair alarms √ √
Provide toileting opportunities Q2hr √ √ √
Educate patient on techniques of how
to get up/walk
√ √ √
Apply Fall Risk Band √ √
Accompany patient while ambulating √ √
Use Ambulatory Devices √ √
Obtain order for PT/OT √ √
Mental Status Compromised:
Telecamera VS. 1:1 Human
√ √
Hourly Rounding √ √ √
Document in EMR √ √ √
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References

Agency for Healthcare Research and Quality. (2021, March). Preventing falls in hospitals.

AHRQ. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/

index.html.

Dykes, P. & Hurley, C. (2021). Patient-centered fall prevention. Nursing Informatics. Wolter

Kluwer Health.

Fall prevention strategies in hospitals. Performance Health. (2022). From

https://www.performancehealth.com/articles/fall-prevention-strategies-in-hospitals

Journal of Nursing Care Quality, 30(2), 106-112.

https://doi.org/10.1097/NCQ.0000000000000085

Jung, H., Park, H., & Hwang, H. (2019). Improving prediction of fall risk using electronic

health record data with various types and sources at multiple times. Computers,

Informatics, Nursing: CIN. Wolters Kluwer Health.

Morse Fall Risk Assessment Scoring:

https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtktool3h.html

NDNQI – National Database for Nursing Quality Indicators (used for definition of a fall.)

Press Ganey. (2022). National Database for Nursing Quality Indicators (fall

definition). https://www.pressganey.com/products/clinical-excellence.

http://www.nursingquality.org/Content/Documents/NQF-Data-Collection-Guidelines.pdf

Staggs, V.S., Davidson, J., Dunton, N., & Crosser, B. (2015, April). Challenges in Defining and

Categorizing Falls on Diverse Unit Types: Lessons from Expansion of the NDNQI Falls

Indicator.