Understanding What is Considered a Fall in Nursing Practice

According to the Centers for Disease Control (CDC), millions of older adults suffer falls each year, leading to emergency room visits. Understanding what is considered a fall in nursing is crucial for accurate reporting and a robust patient safety program.

Quick Summary

A fall in nursing is an unplanned descent to the ground or a lower surface, including assisted or intercepted events, and even when no injury occurs. Official definitions from organizations like the National Quality Forum and CMS help standardize reporting and guide preventative care.

Key Points

• Standard Definition: A fall is any unplanned descent to a lower level, as defined by organizations like NQF and CMS, regardless of whether it results in injury.

• Assisted Falls Count: An event where staff help ease a patient's descent is still a fall and must be reported, though it carries a lower risk of severe injury than an unassisted fall.

• Intercepted Falls are Key: When a staff member catches a patient who has lost their balance, it should be treated as an intercepted fall or near-miss and documented to inform future prevention efforts.

• Categorization is Important: Classifying falls as anticipated, unanticipated, or accidental helps nurses understand the root cause and develop targeted prevention plans.

• Documentation is Crucial: Thoroughly documenting every fall, including circumstances and assessment, is essential for patient safety, quality improvement, and compliance.

• Prevention is Proactive: Understanding the definition and types of falls allows healthcare providers to implement consistent, universal precautions and personalized interventions to reduce risk.

The Official Definition: Unpacking the Details

For healthcare professionals, a standardized definition is critical for tracking incidents and improving patient safety. The National Quality Forum (NQF) defines a fall as an "unplanned descent to the floor (or extension of the floor e.g., trash can or other equipment) with or without injury to the patient". This definition is echoed by other key organizations, including the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS).

This core definition emphasizes two important points:

• Unplanned Descent: The key element is that the movement is unintentional and uncontrolled. This distinguishes it from planned movements, even if they result in the patient being on a lower surface.
• Injury is not a factor: Whether the patient sustains an injury (or not) does not change the classification of the event as a fall. A fall without injury still requires a full assessment and documentation to prevent future, more harmful incidents.

Assisted vs. Unassisted Falls

One of the most common points of confusion is whether an assisted event counts as a fall. In nursing, the answer is a definitive yes. An assisted fall occurs when a patient begins to fall and a staff member is able to intervene, helping to ease their descent to the floor or a lower object. While staff intervention may prevent or minimize injury, the fact that the patient lost control and would have fallen unassisted means the event must be reported as a fall.

Unassisted falls, on the other hand, occur when the patient falls without staff presence to intervene. Research shows that unassisted falls are significantly more likely to result in severe injury, which is why assisted falls, while still undesirable, are considered a more favorable outcome than an unassisted one.

The Role of Intercepted Falls

In some guidelines, an "intercepted fall" is a specific category. This refers to an episode where a resident lost their balance and would have fallen if not for a staff member's intervention, such as catching them. Some frameworks count this as a fall, while others consider it a "near miss." Facilities must follow their specific protocols, but the consensus is that such events indicate a high-risk situation that demands review and preventative measures.

Classifying Falls: More than Just a Report

To better understand and prevent future incidents, nurses often classify falls into categories based on their cause. This allows for targeted intervention strategies.

Common Fall Classifications:

• Anticipated Physiological Falls: These are the most common and occur in patients who are known to be at risk for falling. They are often due to medical conditions or medications that cause weakness, gait instability, or confusion. Example: A patient with Parkinson's disease falls while trying to get out of bed.
• Unanticipated Physiological Falls: These occur due to an unexpected medical event that was not part of the patient's known risk profile. Examples include a sudden stroke or seizure.
• Accidental Falls: These are caused by environmental factors, regardless of the patient's risk status. Examples include tripping over a misplaced object, slipping on a wet floor, or equipment malfunction.

How and Why to Document a Fall

Thorough documentation is a cornerstone of patient safety. Proper reporting is not just about logging an incident; it's a critical tool for analysis, prevention, and legal protection.

1. Immediate Assessment: After ensuring the patient's safety, conduct a head-to-toe assessment. Check for injuries and document vital signs.
2. Describe the Event: Write a clear, objective narrative of what happened. Include the time, location, and the patient's activity at the time of the fall. Avoid making assumptions about the cause.
3. Interventions and Follow-up: Document all nursing actions taken immediately after the fall. This includes notifying the physician and family, implementing any new orders, and updating the patient's care plan.
4. Environmental Review: Note any environmental factors that may have contributed, such as wet floors, clutter, or malfunctioning equipment.

Comparison of Assisted vs. Unassisted Falls

Feature	Assisted Fall	Unassisted Fall
Staff Presence	Staff is present and intervenes as the fall begins.	Staff is not present during the event, or the fall is unobserved.
Likelihood of Injury	Lower risk of significant injury due to controlled descent.	Higher risk of severe injury, including fractures and head trauma.
Reporting Requirement	Must be reported as a fall, triggering assessment and review.	Must be reported as a fall, triggering assessment and review.
Implication for Care	Indicates that staff were attending to the patient's needs and were present during a high-risk activity.	Can point to lapses in supervision, environmental hazards, or changes in patient condition.
Primary Goal	Minimize impact and prevent severe harm during a mobility event.	Target for prevention efforts, as they represent the highest preventable risk of injury.

Conclusion: Preventing Future Incidents

Defining what is considered a fall in nursing is the crucial first step toward prevention. By standardizing reporting and understanding the different types and circumstances of falls, healthcare teams can move beyond simply reacting to incidents. The ultimate goal is to develop and implement proactive, personalized fall prevention strategies. These include environmental modifications, medication reviews, and consistent supervision, all informed by accurate and thorough documentation. By treating every fall, assisted or not, as a critical incident, facilities can foster a culture of safety that reduces risk and protects vulnerable patients.

For more detailed guidance on fall prevention strategies, nurses and caregivers can consult the comprehensive resources available from the Agency for Healthcare Research and Quality (AHRQ), an authoritative source on patient safety.

Agency for Healthcare Research and Quality (AHRQ) Falls Prevention Resources

Frequently Asked Questions

What is the official definition of a fall in a healthcare setting?

The official definition of a fall, used by organizations like the National Quality Forum (NQF) and CMS, is an unplanned descent to the floor or a lower surface, with or without injury.

Is an assisted fall still considered a fall in nursing?

Yes, an assisted fall is still considered a fall. This occurs when a staff member intervenes to help a patient who has lost their balance to the ground. It must be reported, but it is often viewed as a more favorable outcome than an unassisted fall.

If a patient falls but is not injured, does it still need to be documented?

Yes, every fall must be documented, regardless of whether an injury occurred. Falls without injury are still a major indicator of risk and require assessment and preventative interventions to avoid future, more serious incidents.

What is the difference between an intrinsic and an extrinsic fall risk factor?

Intrinsic risk factors are those that originate within the patient, such as impaired mobility or a medical condition. Extrinsic factors are external and environmental, like poor lighting, clutter, or wet floors.

What is an intercepted fall?

An intercepted fall occurs when a patient loses their balance and would have fallen if not for a staff member catching them. Some guidelines classify this as a fall, while others call it a near-miss, but it always warrants review.

Why is accurate fall documentation so important?

Accurate fall documentation is crucial for identifying patterns, assessing patient risk, implementing effective prevention strategies, and ensuring legal compliance. It provides a comprehensive record of the incident for care planning.

What are some common fall prevention strategies in nursing?

Common strategies include assessing a patient's fall risk, ensuring the environment is safe and clutter-free, providing non-slip footwear, keeping the call light within reach, and regular patient rounding.