Enhancing Safety Culture as Part of Fall Prevention Initiatives in Hospitals

Laura M. Cascella, MA, CPHRM

Patient falls are a common risk management and safety concern in various healthcare settings, but particularly in hospitals where patients might be at increased risk of falling due to an "unfamiliar environment, acute illness, surgery, bed rest, medications, treatments, and the placement of various tubes and catheters."¹ The Agency for Healthcare Research and Quality (AHRQ) estimates that between 700,000 and 1 million hospitalized patients in the United States fall each year.²

Although some patient falls result in minimal or no harm, other falls can have severe consequences. MedPro closed claims data over a 10-year period show that more than half of inpatient falls (55 percent) result in clinically severe outcomes, such as death, fractures, head trauma, lacerations, or internal bleeding.³ Patient falls also can have negative ramifications for healthcare staff, such as an increased workload (both in relation to patient care and documentation), poor satisfaction survey results, and liability exposure.

Various patient safety strategies and initiatives are available to help hospitals reduce patient falls. However, successful implementation of these strategies can hinge on each organization's commitment to a culture of safety and transparency. AHRQ notes that "Achieving a culture of safety requires an understanding of the values, beliefs, and norms about what is important in an organization and what patient safety attitudes and behaviors are expected and appropriate."⁴

Hospital leaders, providers, and staff members should consider the following characteristics of a robust safety culture to identify ways in which their organization is succeeding as well as areas for improvement:

• The organization has well-defined and documented safety protocols. These protocols are reviewed and updated periodically and when changes occur in workflows, systems, staffing, etc.
• The organization's safety protocols clearly outline the types of incidents that require reporting and the appropriate reporting method.
• The organization's leaders support safety initiatives — including fall prevention programs — through goal setting, resource allocation, and training opportunities.
• The organization has a code of conduct/ethics statement that promotes professionalism and encourages respectful and courteous communication.
• The organization promotes psychological safety and supports a nonpunitive approach to staff feedback and risk identification. Speaking up behavior is encouraged, and providers and staff members do not fear retaliation when reporting safety issues.
• Safety incidents are viewed as learning opportunities. When an incident occurs, the problem — not the individual(s) involved — is the focus of investigation and corrective actions.
• A system is in place to evaluate corrective actions and their effectiveness as well as to provide feedback to providers and staff about the results of these actions.
• The organization's leaders empower providers and staff to make decisions and changes that support quality improvement.
• The organization supports truthful and transparent communication with all healthcare providers and staff members.
• The organization measures performance and quality indicators and educates providers and staff members about data trends.
• Hospital units work individually and collectively to improve care coordination and identify potential gaps in communication and information transfer. Unit staff have input into tailoring fall prevention strategies for their units.
• The organization has a designated fall prevention team to evaluate fall risks, review incidents of falls, implement safety protocols, and monitor results.
• The fall prevention team includes appropriate representatives from across the organization, such as physicians, nurses, nursing assistants, physical therapists, occupational therapists, risk managers, facility engineers, and environmental services staff.
• The organization provides training that raises awareness about patient falls, their potential adverse outcomes, and the organization's commitment to fall prevention.

For more information about enhancing safety culture and improving your hospital's fall prevention program, see AHRQ's comprehensive resource titled Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. For curated resources on this topic, see MedPro's Risk Resources: Fall Prevention in Hospitals.

Endnotes

¹ Dykes, P. C., Carroll, D. L., Hurley, A. C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? The Journal of Nursing Administration, 39(6), 299–304. doi: https://doi.org/10.1097/NNA.0b013e3181a7788a

² Agency for Healthcare Research and Quality. (2019, September 7). Patient safety primer: Falls. Retrieved from https://psnet.ahrq.gov/primer/falls

³ MedPro Group closed cases, 2013–2022, inpatient fall allegations.

⁴ Agency for Healthcare Research and Quality. (2013, January). Preventing falls in hospitals: A toolkit for improving quality of care. Tool 1A: Hospital survey on patient safety culture. Retrieved from www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/hospital-survey.html

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