15 Ways Hospitals Can Improve Environmental Safety and Reduce Falls

Laura M. Cascella, MA, CPHRM

Patient falls are a vexing and persistent problem for hospitals. A collaborative publication from The Joint Commission, the Health Research and Educational Trust, and the American Hospital Association notes that “Despite long-term and widespread attention to fall prevention, patients continue to fall, and many of these falls result in injury.”¹

Although falls occur in all types of healthcare settings, they are particularly concerning in inpatient settings. Malpractice case data show that 42 percent of inpatient falls result in clinically severe patient injuries, compared with 20 percent in outpatient settings and 30 percent in emergency settings.² Malpractice cases involving inpatient falls also are more expensive to resolve than fall cases occurring in other settings.³

The factors that contribute to patient falls in hospitals are numerous and sometimes complex, resulting in a problem that has no simple or universal solution. In some situations, patients might fall because of medical conditions, cognitive impairments, medications, unanticipated medical events (e.g., a seizure), or intrinsic factors. In other instances, patients might fall simply as a result of being unfamiliar with the physical space or because of environmental hazards, such as a poorly placed piece of furniture, a cord, or clutter.

Preventing all patient falls is unlikely — particularly ones resulting from medical conditions or impairments. But hospitals can improve environmental safety and reduce the risk of patients falling because of seemingly benign, but potentially dangerous, external factors. The following 15 safety precautions can assist hospitals in their fall prevention efforts:

1. Consider patients’ risk of falling when assigning room locations, and locate high-risk patients in view of, or close to, nursing stations.
2. Orient new patients to the environment so they are familiar with the location and any potential obstacles. Patients who have cognitive impairments might require periodic reorientation.
3. Ensure that your facility has appropriate signage and that the wording is clear and understandable.
4. Teach patients when and how to properly use the call system; ask them to demonstrate their understanding of how the system works. Make sure that the controls for the call system are within each patient’s reach.
5. Organize patients’ personal items — particularly items they frequently use — within their reach.
6. Install sturdy handrails in patient rooms, bathrooms, and hallways.
7. Teach and encourage patients to properly use assistive devices (e.g., walkers, wheelchairs, and canes).
8. Keep hospital beds in a low position at all times, except when transferring patients from beds or providing patient care.
9. Keep hospital bed brakes locked unless the bed is being moved, and make sure wheelchair wheels are locked when patients are transferring in or out of chairs or the chairs are stationary.
10. Make sure protective equipment and supplies are readily available and fully utilized (e.g., grab bars, hip protectors, individualized wheelchair seating, alarms/sensors, and nonslip footwear in various sizes).
11. Educate staff members about safe patient handling practices, and routinely monitor them for compliance.
12. Use night lights or supplemental lighting to help patients move safely in low-light areas and situations.
13. Keep floor surfaces clean and dry. Clean up all spills promptly, and use “wet floor” signs as appropriate.
14. Regularly assess the environment, including patient rooms and common areas, for potential fall hazards (e.g., clutter, cords, poorly designed furniture, sharp edges, carpeting hazards, etc.).
15. Implement a mechanism for reporting and reviewing potentially dangerous environmental conditions. Educate staff members about reporting procedures.⁴

These strategies represent a sample of actions that hospital leaders, providers, and staff can take to help prevent patient falls resulting from environmental factors. Other fall prevention strategies involve consideration of patients’ physical and cognitive limitations, history and risk of falling, medications, and more.

For more information about implementing fall prevention strategies and programs, see the MedPro’s Risk Resources: Fall Prevention in Hospitals.

Endnotes

¹ Health Research & Educational Trust. (2016, October). Preventing patient falls: A systematic approach from the Joint Commission Center for Transforming Healthcare project. Retrieved from www.hpoe.org/Reports-HPOE/2016/preventing-patient-falls.pdf

² MedPro Group and MLMIC hospital patient fall cases opened 2013–2023.

³ MedPro Group and MLMIC patient fall cases closed 2013–2023.

⁴ Health Research & Educational Trust, Preventing patient falls: A systematic approach from the Joint Commission Center for Transforming Healthcare project; Agency for Healthcare Research and Quality. (2013, January). Preventing falls in hospitals: A toolkit for improving quality of care. Retrieved from www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html; ECRI. (2012). Self-assessment: Falls. Health System Risk Management. Retrieved from www.ecri.org/components/HRC/Pages/SAQ1.aspx

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