15 Ways Hospitals Can Improve Environmental Safety and Reduce Falls

Laura M. Cascella, MA, CPHRM

Patient falls continue to represent 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. MedPro closed claims data show that 48 percent of inpatient falls result in clinically severe patient injuries compared with 17 percent in outpatient settings and 15 percent in emergency settings. Malpractice cases involving inpatient falls also are 30 percent more expensive to resolve than all fall cases.²

The factors that contribute to patient falls in hospitals are numerous and sometimes complex, resulting in a problem that has no simple or global solution. In some situations, patients might be at a high risk of falling due to medical conditions, cognitive impairments, medications, or other intrinsic factors. Some patients might fall as a result of an unanticipated medical event, such as a seizure. 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.

Although preventing all patient falls is unlikely — particularly ones resulting from medical conditions or impairments — 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:³

1. Consider patients’ risk of falling when assigning room locations, and locate high-risk patients in view of, or close to, the nursing station.
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 repeat or periodic reorientation.
3. Ensure that appropriate signage is used in the facility and that the wording is clear and readable.
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 the patient’s reach.
5. Organize patients’ personal items — particularly frequently used items — 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 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.

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

For more information about implementing a comprehensive fall prevention program, see the Agency for Healthcare Research and Quality’s Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care.

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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. (2020). Data insight: Patient falls. Retrieved from www.medpro.com/documents/10502/5086245/Data+Insight_Patient+Falls_MedPro+Group.pdf

³ 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; Boushon, B., et al. (2012). How-to guide: Reducing patient injuries from falls. Institute for Healthcare Improvement. Retrieved from www.ihi.org/resources/Pages/Tools/TCABHowToGuideReducingPatientInjuriesfromFalls.aspx

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