Take a big step toward falls prevention

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Keeping patients safe at your facility

With patient safety at the forefront and the new Centers for Medicare & Medicaid Services ruling, which takes effect in October, stating Medicare will not pay for treatment of injuries resulting from preventable patient falls, staff educators are looking for quick, effective strategies to reduce fall rates at their hospitals and keep all of their patients safe from injuries.

“Every hospital should have a falls prevention plan,” says Shirley Frost, RN, MSN, director of education at Berlin (WI) Memorial Hospital.

Although falls can occur among all patient populations, studies confirm that falls and subsequent injuries pose particular dangers to elderly patients. According to a recent article in the journal American Family Physician, “Falls are one of the most common geriatric syndromes threatening the independence of older persons. Falls are associated with increased morbidity, mortality, and nursing home placement.”

Candy Madera, RN, BSN, staff development coordinator for Blue Mountain Health System in Lehighton, PA, says that certain precautions should be taken across all facilities to prevent falls.

“It’s all about looking at reduction strategies,” she says. “And it has to be an ongoing thing.”

Frost and Madera have provided policies and precautions used at their hospitals to help reduce the risk of patient falls.

Berlin Memorial

Patients at Berlin Memorial are assessed on admission using the Morse Scale, which rates patients on several variables, including history of falling, gait, and mental status.

A high score indicates a high risk of the patient falling; a score of 45 or greater places the patient under fall precautions and puts the patient on the hospital’s Falls Risk Care Plan. If a patient’s situation changes, he or she will be immediately reassessed. (See the “Sample assessment form” on p. 3 of the PDF of this issue.)

The scale does not reference medications, but Frost says the hospital is planning to include a section within the scale about medications early this spring, as certain medications can put patients at a greater risk of falling. “That piece we found lacking,” she says.

Once patients are on the care plan, they receive a yellow name band, and a yellow sticker is put on their chart. The hospital pharmacy is notified to assess the patients’ medications to identify those that may increase the risk for falls, and a yellow magnet is placed on the door frame to indicate the patient is a high fall risk. “That way, if people walk by that room and see the patient moving, they can address it right away by either helping the patient move or finding someone else to provide assistance,” says Frost.

Practical steps taken at Berlin Memorial to help prevent patient falls include:

Keeping beds in low positions

Checking that bed side rails are up

Making sure call lights are within patients’ reach

Assisting patients to the restroom

Frost has come to view the system as highly effective, saying that the total number of falls at Berlin Memorial has lowered as a result of the initiatives. “It has worked well for us,” she says.

Blue Mountain Health System

Educators at Blue Mountain worked together with other hospital workers, including physical therapists and radiologists, to take action regarding fall prevention.

“We had a fall task force that got together to come up with reduction strategies,” says Madera. “We wanted to be proactive in our risk assessment.”

The group found a tool they liked called the Schmid Tool. Like the Morse Scale, this tool uses a number system; it rates the patient from zero to 2 on a variety of categories (e.g., mobility, medication, etc.).

A score of 3 or greater indicates the patient is a fall risk. “It works well for us,” says Madera. “It’s user-friendly and very short, so you can quickly identify risks.”

Patients are assessed with the tool upon admission, and are reassessed every three days or whenever a significant change in condition occurs.

In its quest to be proactive concerning patient falls, Blue Mountain has taken specific steps to keep patients safe, such as:

Communicating a patient at fall risk to the charge nurse (CN) so that the CN is able to ensure that fall prevention strategies are in place

Activating a bed alarm system

Ensuring no clutter is around the bed or bathroom

Like patients at Berlin Memorial, Blue Mountain patients are given yellow name bracelets so that staff members can quickly identify whether they are at a high risk of falling. Additionally, a falling star is put on the outside of the patient’s door to make clear they are a high fall risk. “This way, all ancillary people from dietary to respiratory know that the patient is a fall risk,” says Madera.


Shobha, S. (2005). “Prevention of falls in older patients,” American Family Physician 72 (1): 81–88.