NursingLevel: Intermediate

Fall Prevention in Hospital: An Evidence-Based Practice Example

Prepared by the Assignment Achievers nursing team.

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Problem Statement / Assignment Scope

Falls are one of the most common causes of injury to patients in hospital. For an adult medical-surgical ward, write a PICOT question and outline an evidence-based plan to reduce the fall rate.

Prerequisites: Writing a PICOT question, basic research appraisal, and ward safety procedures.

Step-by-Step Worked Solution

1. The PICOT question

(P) For adult patients on an acute medical-surgical ward, (I) does purposeful hourly rounding, (C) compared with responding to call bells only, (O) reduce the number of falls (T) over six months?

2. What the plan includes

Risk assessment: the Morse Fall Scale on admission, every shift, and again after a fall or a change in condition.
Purposeful rounding, "the 4 Ps": ask about pain, help with position, offer the toilet ("potty"), and leave possessions such as the call bell, glasses and water within reach.
A safer environment: non-slip footwear, the bed at its lowest height, cables and clutter off the floor, and night lights on.

3. Measuring the result

Compare falls per 1,000 patient days for six months before and after the change, and audit how consistently rounding happens. If the rate doesn't fall, check whether the plan was followed before deciding it doesn't work.

Key Takeaways & Core Principles

Many unplanned call-bell requests are about toileting and repositioning, which rounding deals with in advance.
Fall risk changes: reassess after new medicines such as sedatives or blood pressure tablets.
Combining several measures works better than relying on one, such as a bed alarm alone.
Report falls per 1,000 patient days so wards of different sizes can be compared.

Frequently Asked Questions

What Morse Fall Scale score is high risk?

Many hospitals treat a score of 45 or more as high risk and start their high-risk precautions straight away. Check the cut-off your placement uses, as some set it differently.

Academic References & Standards

[1]Agency for Healthcare Research and Quality. (2023). Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. Source Link

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