Understanding Where do most falls occur in the hospital?

According to the Agency for Healthcare Research and Quality (AHRQ), between 700,000 and 1,000,000 patient falls happen in U.S. hospitals annually. Understanding where do most falls occur in the hospital? is the first step toward effective prevention and enhancing patient safety.

Quick Summary

Most patient falls in a hospital setting occur within the patient's room, especially around the bed and during trips to the bathroom, often due to unfamiliar surroundings, medication side effects, or confusion.

Key Points

• Patient Room is the Riskiest Area: Most hospital falls happen within the patient's own room, especially near the bed and in the bathroom.

• Toileting is a Major Trigger: Urgency combined with disorientation and environmental hazards makes trips to the bathroom a leading cause of falls.

• Risks are Multifactorial: Falls are caused by a combination of intrinsic factors like patient age and medication effects, and extrinsic factors like environmental clutter and staffing issues.

• Prevention is a Team Effort: Effective fall prevention requires collaboration between hospital staff, patients, and their families, utilizing assessments, education, and environmental safety measures.

• Be Your Own Advocate: Patients can reduce their risk by using the call bell, wearing proper footwear, and getting up slowly to prevent dizziness.

The Patient Room: The Primary High-Risk Zone

Studies consistently show that the majority of patient falls occur inside the patient’s own room. While hallways and common areas pose risks, the patient room is the most concentrated area for fall incidents. This is because patients spend the most time here and perform routine activities that require movement, such as getting out of bed or using the restroom.

The Bedside: Navigating Transitions

One of the most frequent locations within the patient room for a fall is right beside the bed. This often happens when a patient is attempting to get in or out of bed. Patients may feel steady while lying down but experience dizziness or weakness when sitting or standing. Contributing factors include:

• Altered Status: Post-surgery or due to acute illness, a patient may be weaker or more disoriented than they perceive.
• Reaching for Items: Attempting to reach for the call button, a glass of water, or a phone that is out of reach can cause a patient to overstretch and lose their balance.
• Bed Exit Alarms: Ineffective or unset bed alarms can fail to alert staff when a patient tries to leave the bed unassisted.

Toileting-Related Falls

Toileting-related activities are a leading cause of falls in the hospital, accounting for approximately half of all incidents in some studies. The path to and from the bathroom and the activity within the bathroom itself are particularly hazardous.

• Urgency: Patients, especially older adults, may feel an urgent need to use the bathroom and attempt to rush, increasing their fall risk.
• Environmental Hazards: The bathroom presents unique risks, including wet and slippery floor surfaces, narrow spaces, and lack of grab bars in accessible locations.
• Delay in Response: When the call light is not answered promptly, a patient may feel they have no choice but to attempt the trip to the toilet alone.

Why Falls Happen: A Multifactorial Problem

Patient falls in the hospital are not caused by a single factor but by a complex combination of intrinsic (patient-related) and extrinsic (environmental) risk factors.

Intrinsic Risk Factors

• Age: Being over 65 is a significant risk factor.
• Cognitive Impairment: Conditions like delirium, dementia, or general confusion can impair a patient's judgment and awareness of their surroundings.
• Medication Effects: Sedatives, diuretics, and other medications can cause dizziness, confusion, or orthostatic hypotension (a drop in blood pressure when standing).
• Mobility Issues: Gait instability, muscle weakness, balance impairment, and the need for assistive devices all contribute to risk.

Extrinsic Risk Factors

• Unfamiliar Environment: Being in a new and different setting, especially at night, can disorient patients.
• Environmental Obstacles: Clutter, medical equipment, and other items in a patient's path can create tripping hazards.
• Wet Floors: Spills from water or incontinence can make floor surfaces slippery.
• Inadequate Staffing: Insufficient staffing levels can lead to delayed responses to call bells, prompting patients to get up unassisted.

Comparison of In-Room vs. Non-Room Fall Risks

Location	Activity-Related Risks	Environmental Risks	Time of Day	Typical Patient Profile
Patient Room	Getting in/out of bed, toileting, reaching for items, transfers.	Obstacles like tubing, clutter, and wet bathroom floors.	Day and night, especially overnight when urgency and darkness combine.	Confused, elderly, weak, or medicated patients.
Corridors	Ambulating to other departments or physical therapy, rushing to the bathroom.	Wet floors from spills, tripping over equipment.	When patients are more mobile, such as during daytime hours.	Patients with poor gait or balance, or those on sedative medication.

Effective Strategies for Fall Prevention

Hospitals use a multi-faceted approach to reduce fall risks, integrating several strategies to protect patients:

1. Individualized Fall Risk Assessments: Staff should use standardized tools like the Morse Fall Scale to assess a patient's risk upon admission and throughout their stay. This helps tailor the prevention plan.
2. Environmental Modifications: Ensure the patient's room is decluttered, well-lit, and the path to the bathroom is clear. Hospital beds should be kept in a low position with wheels locked when stationary.
3. Scheduled Toileting: Proactive toileting schedules for high-risk patients can reduce the urgent need to get up alone.
4. Patient and Family Education: Educating patients and their families on fall risks and the importance of using the call bell is crucial.
5. Medication Review: Pharmacists and doctors can review medications to identify and adjust those that increase fall risk, like sedatives.
6. Use of Assistive Devices: Ensure patients use their prescribed walking aids, and that these are readily available and in good condition.

What Patients and Families Can Do

As a patient or visitor, you can be an active participant in preventing falls. Your awareness and actions can significantly improve safety.

• Use the Call Bell: Always use the call bell for assistance with getting out of bed, going to the bathroom, or reaching items, even if it feels like a simple task.
• Wear Proper Footwear: Wear non-slip, well-fitting footwear. The hospital may provide non-skid socks.
• Get Up Slowly: When getting out of bed or a chair, move slowly and pause to ensure you feel steady and not dizzy before standing.
• Keep Paths Clear: Ensure the pathway from the bed to the bathroom is free of clutter, equipment, and other tripping hazards.
• Inform Staff: Tell the staff if you feel unsteady, dizzy, or have a history of falls.
• Stay Hydrated: Drinking enough water can prevent dehydration-related dizziness.

For more detailed guidance and resources on patient safety in hospital settings, visit the Agency for Healthcare Research and Quality (AHRQ) website. Visit AHRQ's Patient Safety Network for Falls Information

Conclusion: A Proactive Approach is Essential

While the majority of hospital falls occur in the patient's room, they are not inevitable. By understanding the common locations and underlying risk factors, both healthcare providers and patients can work together to implement proactive and preventative measures. Through vigilant assessment, environmental modifications, and clear communication, the risk of falls can be significantly reduced, leading to safer hospital stays and better patient outcomes.

Frequently Asked Questions

What time of day do most hospital falls occur?

While falls can occur at any time, studies have shown that a significant proportion happen during the evening or overnight hours. This can be due to reduced visibility, altered sleep cycles, or increased confusion during these times.

Are older patients more likely to fall in the hospital?

Yes, older adults, particularly those over 65, are at a significantly higher risk of falling in the hospital. Factors contributing to this include age-related muscle weakness, multiple medical conditions, and increased medication use.

How do medications contribute to hospital falls?

Certain medications can increase fall risk by causing side effects like dizziness, confusion, sedation, and a drop in blood pressure when standing (orthostatic hypotension). Hospital staff should regularly review a patient's medication list to mitigate this risk.

What is a 'fall risk assessment' and why is it important?

A fall risk assessment is a tool used by hospital staff to evaluate a patient's likelihood of falling based on their medical history, mobility, and cognitive state. The assessment helps tailor a specific prevention plan to address the patient's unique risk factors.

What should a patient do if they need to go to the bathroom and feel unsteady?

A patient who feels unsteady or weak should always use the call bell to ask for assistance. Attempting to go alone, especially with urgency, significantly increases the risk of a fall. It is safer to wait for a staff member to help.

Why is keeping the patient room clear of clutter important?

A cluttered room presents tripping hazards like medical cords, personal items, or furniture that can increase the chance of a fall, especially for a disoriented patient. Keeping clear pathways is a simple but effective preventive measure.

What kind of footwear should a patient wear to prevent falls?

Patients should wear well-fitting, sturdy, and non-slip footwear. Hospitals often provide special non-skid socks for this purpose. Loose-fitting slippers or walking in bare feet should be avoided.