6th Edition In-Depth: Preventing Falls in Inpatient and Outpatient Settings

Standard IPSG.6The hospital develops and implements a process to reduce the risk of patient harm resulting from falls for the inpatient population.

Standard IPSG.6.1The hospital develops and implements a process to reduce the risk of patient harm resulting from falls for the outpatient population.

Patient falls continue to be a top adverse event in hospital settings, often resulting in injury and even death. Although fall risk is more common among elderly and frail patients, any patient can be at risk for a fall due to physiological changes related to medications, surgery, procedures, diagnostic tests, or a medical condition, among other factors. In addition, the patient’s location, or physical environment, should be considered as it may be a factor leading to increased fall risk. Despite these risks, many falls are preventable in the hospital’s inpatient and outpatient settings. An important element to preventing falls is implementing appropriate measures and interventions for those patients, situations, and locations assessed to be at risk.

In the 6th Edition hospital standards, Goal 6 of the International Patient Safety Goals (IPSGs) has been divided into two standards — IPSG.6 addresses fall risk prevention for inpatients and IPSG.6.1, for outpatients. Both standards clarify that fall risk tools and methods need to be appropriate for the patients being served. For example, pediatric patients require a fall risk tool developed specifically for pediatrics as it takes into account risk factors that are not present in a tool designed for adult patients. Another example — obstetric patients have unique fall risk factors, and often hospitals use tools developed for geriatric or medical-surgical patients. There are assessment tools specific to obstetric patients, and when used, they may reduce fall risk during hospitalization. In light of these examples, appropriate assessment tools are essential for improving patient safety.

The criteria and score/status that identify patients at risk for falls and any interventions applied need to be documented in the patient’s medical record. This information facilitates coordination of care among the patient’s health care practitioners, which promotes consistent and efficient fall-risk prevention efforts.  

As required in IPSG.6, all inpatients are assessed for fall risk, and those at risk are reassessed during their hospitalization. Inpatients whose fall risk status is initially found to be low may change during their hospital stay. For example, if a patient has been placed on a new medication or received a treatment or intervention, with or without sedation, a risk for falls may increase. The hospital implements a process to reassess such patients for fall risk. In addition, hospitals may wish to examine their fall adverse event data to see if there are areas for fall risk that have not been identified. Actions should be implemented to improve fall risk prevention as it relates to these data.

Standard IPSG.6.1 addresses fall risk in the hospital’s outpatient departments and services. This standard differs from IPSG.6 in that outpatients are screened for fall risk. Not all outpatients are screened given the general nature of outpatient visits. However, in the context of the patients served and the care and services provided, the hospital determines which outpatients are screened, taking into account physiological factors as well as environmental factors. Such patients may include those in an outpatient physical therapy department, patients arriving by ambulance from a long term care facility for an outpatient procedure, patients scheduled for outpatient surgery, patients with obvious gait or balance disturbances, pediatric patients under the age of two, and so on. These examples may or may not be relevant to a hospital’s patient population or services. It is up to the hospital to identify the types of outpatients who are screened.

Fall risk screening often involves a tool, which may include a minimal number of yes/no questions that get assigned a numerical score based on the patient’s answers. If the results of screening indicate the outpatient is at risk for falls, interventions are implemented to reduce risk. In the outpatient setting, screening generally provides the information needed to identify appropriate fall-risk interventions. The organization may wish to perform an in-depth assessment following screening for specific outpatients or situations; however, it is up to the organization to make this determination and not a requirement in IPSG.6.1.

Evidence-based tools for fall-risk screening and assessment can be found in the research literature and from international organizations and agencies. The following resources may be helpful in identifying tools, methods, and processes relevant to the hospital’s inpatient and outpatient populations.