Happy first day of autumn! Let’s have some fall talk.

If you spend any time in the acute care setting, you’ll be inundated with signs of fall precautions: yellow alert armbands, yellow nonslip socks, yellow signs on patient room doors, and of course the constant ringing of bed alarms.

It appears that hospitals put a lot of effort into fall prevention, and understandably so—falls cost hospitals money. These costs include tests and procedures that aren’t covered by insurance, increased length of stay while the patient recovers, and lawsuits from injured patients or from their families.

Checking boxes vs. individual patient needs.

However, the current approach of applying all precautions to all patients at risk for falling isn’t supported by research, and may decrease patient satisfaction. Sometimes it seems more focus is put on checking boxes about having prevention strategies in place than on the actual patient’s preferences or needs. For example, a former patient told me about a time she was in the bathroom of her hospital room and felt lightheaded. Rather than risk falling, she eased herself to the floor and hit the call bell for assistance to get back to bed. Upon finding her on the floor, the staff were so focused on filling out an incident report and assessing her for injury that they ignored her attempts to explain what actually happened.

The ‘next era’ in fall reduction.

Many of the strategies mentioned in the first paragraph focus on a blanket approach to falls, with the primary focus on reducing extrinsic or environmental risk factors. These common interventions may be helpful to some degree; however, they also put limits on patients’ mobility and autonomy.

A CE article in AJN’s October issue, “Reimagining Injurious Falls and Safe Mobility,” by Ann Hendrich, PhD, RN, FAAN, proposes the “next era” in fall reduction practices and proposes an acronym based on a three-pillared approach to fall prevention.

ERA stands for

  • Electronic health record integration
  • Risk factors that matter
  • Assessment and care plans

The author recommends incorporating a valid tool for fall risk assessment into the EHR, where fall risk score can be recorded and updated as the patient’s condition changes. The tool selected should be valid for predicting falls, such as the Hendrich II Fall Risk Model. Once the risk factors are determined, a care plan can be created based on the 4Ms: What Matters, Mentation, Medication, and Mobility.

You can read more about this in this month’s CE feature, in which you’ll find a detailed explanation of the ERA approach and the 4Ms, infographics of the model and framework, a case study, and practice recommendations. You can also take the test and earn CE credits.

Please comment below and let us know what your facility is doing to prevent patient falls.

Christine Moffa, PhD, APRN, PMHNP-BC, senior clinical editor