Essential Guide: How to Prevent a Patient From Falling in the Ward

Each year in the U.S., between 700,000 and 1,000,000 people fall in the hospital. This guide details crucial strategies that answer: how to prevent a patient from falling in the ward? These proactive measures are vital for enhancing patient safety and care.

Quick Summary

Preventing patient falls requires a multi-faceted approach, starting with individualized risk assessments and consistent environmental checks. Key strategies include purposeful hourly rounding, medication reviews, and clear communication among the care team and patient.

Key Points

• Universal Precautions are Key: Every patient benefits from baseline safety measures like clear pathways and keeping call bells within reach.

• Individualize the Plan: A one-size-fits-all approach fails. Use tools like the Morse Fall Scale to create personalized care plans based on specific risk factors.

• The Environment Matters: Simple changes like proper lighting, non-slip floors, and removing clutter are highly effective at preventing falls.

• Review Medications: Polypharmacy is a major risk factor. Regularly review medications with a pharmacist to identify drugs that may cause dizziness or confusion.

• Communicate and Round: Proactive hourly rounding and clear communication between shifts and with the patient are critical for anticipating needs and preventing unassisted movement.

• Technology is an Aid, Not a Solution: Bed alarms and virtual sitters can help, but they must supplement, not replace, attentive nursing care and a safe environment.

The Critical Importance of Fall Prevention in Hospitals

Patient falls are the most frequently reported adverse event in adult inpatient units, with up to one-third resulting in injury. Preventing these incidents is not just about avoiding injury; it's about maintaining a patient's quality of life, reducing hospital stays, and managing healthcare costs. A comprehensive fall prevention program is a hallmark of high-quality patient care. It requires a proactive, team-based effort that combines thorough assessment, personalized interventions, and a safe environment.

Step 1: Comprehensive and Continuous Risk Assessment

The foundation of any successful fall prevention strategy is identifying which patients are at risk. This is not a one-time task upon admission but an ongoing process.

Universal Fall Precautions: Every patient should be treated with a baseline level of precaution. This includes orienting them to their room, ensuring the call bell and personal items are within reach, keeping the bed in a low and locked position, and maintaining a clutter-free environment.

Individualized Risk Factor Assessment: Beyond universal precautions, a detailed assessment should identify specific risks. Key factors to evaluate include:

• History of Falls: A previous fall is a strong predictor of future falls.
• Mobility and Gait: Issues with balance, strength, or ability to walk safely.
• Medications: Polypharmacy, or specific drugs like sedatives, antidepressants, and some heart medications, can cause dizziness or confusion.
• Cognitive State: Patients with delirium, dementia, or confusion are at higher risk.
• Toileting Needs: Urgency, frequency, or needing assistance to use the bathroom increases risk, as this is a common time for falls.
• Sensory Impairment: Poor vision or hearing can prevent a patient from identifying hazards.

Validated tools like the Morse Fall Scale or the Hendrich II Fall Risk Model can standardize this process, but they should always be supplemented by clinical judgment and direct communication with the patient and their family.

Step 2: Creating a Safe and Optimized Ward Environment

The physical space plays a significant role in patient safety. Simple modifications can drastically reduce the likelihood of slips, trips, and falls.

Key Environmental Interventions:

1. Lighting: Ensure rooms and hallways are well-lit, especially at night. Use night lights to illuminate the path to the bathroom.
2. Flooring: Keep floors clean, dry, and free of spills. Non-slip flooring is ideal. Remove tripping hazards like loose rugs, clutter, and electrical cords.
3. Bed and Room Setup: Keep the bed in its lowest position when the patient is resting. Ensure bed and wheelchair brakes are locked during transfers. Keep essential items (water, phone, call bell) within easy reach to prevent the patient from stretching or getting up unassisted.
4. Bathroom Safety: Install grab bars in the toilet and shower areas. Use non-slip mats in the tub or shower.
5. Proper Footwear: Ensure patients wear well-fitting, non-slip socks or shoes. A patient's own footwear is often the safest option if it meets these criteria.

Step 3: Patient-Centered and Team-Based Interventions

Once risks are identified, the care team must implement an individualized plan. This requires clear communication and consistent execution.

Proactive Rounding: Intentional or purposeful hourly rounding is a proactive strategy to address patient needs before they feel the need to get up on their own. This involves checking on pain, positioning, personal needs (like toileting), and placement of personal items. This simple, scheduled check-in can significantly reduce fall rates.

Medication Management: A pharmacist or physician should regularly review a patient's medications to identify and mitigate risks. Adjusting dosages, changing medication times, or discontinuing non-essential drugs that cause drowsiness or orthostatic hypotension can be a powerful intervention.

Utilizing Technology: While not a replacement for good nursing care, technology can be a valuable aid.

• Bed and Chair Alarms: These alert staff when a high-risk patient attempts to get up. However, they can lead to alarm fatigue and may not be suitable for all patients, especially those with cognitive impairments.
• Virtual Sitters: Centralized video monitoring allows a single staff member to watch multiple at-risk patients, alerting the floor nurse if a patient is trying to stand.
• AI-Powered Monitoring: Advanced systems use sensors and artificial intelligence to predict when a patient is about to get out of bed, providing a more proactive alert to staff.

For more in-depth guidance on implementing a fall prevention program, the Agency for Healthcare Research and Quality (AHRQ) offers a comprehensive toolkit.

Comparison of Fall Prevention Strategies

A successful program balances universal precautions with targeted, risk-specific actions.

Strategy Type	Examples	Best For	Considerations
Universal (Proactive)	Hourly rounding, clear pathways, bed in low position, non-slip socks	All patients	Establishes a baseline culture of safety. Prevents low-risk patients from becoming high-risk.
Targeted (Reactive)	Bed alarms, 1:1 sitters, physical restraints	High-risk patients (e.g., severe confusion, impulsivity)	Can be resource-intensive. Restraints are controversial and may increase injury risk.
Environmental	Grab bars, improved lighting, decluttering	All patients, especially those with mobility or vision issues	One-time modifications that provide continuous benefit. Highly effective.
Clinical	Medication review, physical therapy consultation, vision checks	Patients with specific medical risk factors	Addresses the root cause of the fall risk, leading to more sustainable prevention.

Conclusion: A Culture of Safety

Ultimately, learning how to prevent a patient from falling in the ward is about fostering a culture of safety. It's a shared responsibility that involves the entire healthcare team, from nurses and doctors to pharmacists and environmental services staff. By combining systematic risk assessment with tailored environmental and clinical interventions, hospitals can significantly reduce the incidence of falls, protecting patients from harm and ensuring a safer care journey for everyone.

Frequently Asked Questions

What is the most common cause of patient falls in a hospital?

While multifaceted, common causes include mobility issues (weakness, poor balance), the effects of medications (dizziness, drowsiness), an unfamiliar environment, and urgent needs like having to use the toilet.

How can you help prevent a family member from falling in the hospital?

Ensure their call bell and personal items are always within reach. Make sure they wear non-slip footwear. Communicate any concerns about their mobility, confusion, or previous falls to the nursing staff. Help keep their room clutter-free.

What is a 'universal fall precaution'?

It is a set of standard safety practices applied to every patient, regardless of their fall risk. This includes actions like keeping the bed low, locking wheels on beds and wheelchairs, maintaining a clear path, and ensuring the patient knows how to use the call bell.

Are bed rails effective at preventing falls?

The effectiveness of bed rails is debated. While they can help a patient reposition themselves, they are not a foolproof solution. For a confused or agitated patient, they can become a hazard if they try to climb over them, potentially leading to a more serious fall.

What is the Morse Fall Scale?

The Morse Fall Scale is a widely used clinical tool to assess a patient's risk of falling. It scores a patient based on six variables: history of falling, secondary diagnosis, ambulatory aid, IV/heparin lock, gait/transferring, and mental status.

Why is toileting a high-risk activity for falls?

Toileting often involves urgency, getting up from a low position (especially at night), navigating to the bathroom, and transferring on and off the toilet—all activities that challenge balance and strength, increasing fall risk.

Should patients wear their own shoes in the hospital?

If the patient's own shoes are well-fitting, have a closed back, and feature a non-slip sole, they are often a great option. Hospital-provided non-slip socks are a good alternative if the patient's own footwear is not suitable.