Hospital Fall Prevention Practices and Implementation Strategies: A Multisite Observational Study

OBJECTIVES: Our study examined the current fall prevention practices and implementation strategies used by the US hospitals. METHODS: We conducted a cross-sectional, descriptive study of 24 general hospitals and 26 adult general medical units (i.e., medical wards). We administered a survey to obtain an inventory of 5 domains of fall prevention practices currently used: visibility and identification, bed modification, patient monitoring, patient safety, and education. We also measured 5 domains of implementation strategies to enhance staff adherence to the hospital's fall prevention protocol and practices: leadership, provider education, audit-and-feedback, network and collaboration, and local opinion leaders. RESULTS: Of the 24 hospitals, 58% had <200 beds and 50% were teaching sites. Hospital leadership had expectations for fall prevention but varied in consistency in types of fall prevention practices and in implementation approaches. Several major themes emerged: heavy reliance on nursing personnel; inconsistency in evidence-based fall prevention practices with an overreliance on less time-intensive, low-value practices; systems designed to support universal rather than patient-tailored fall prevention strategies; and few implementation strategies to enhance uptake and adherence to fall prevention protocols. CONCLUSIONS: There is substantial variation in US hospitals' choice of fall prevention practices and a lack of implementation strategies to enhance staff adherence to the practices. The findings suggest a critical need for more standardized, evidence-based, and individualized approaches to effectively reduce falls.