Target those most at risk of falls, but others too

Fall prevention efforts usually target those thought most likely to fall, but does that leave the other patients at risk if no one is paying attention to their potential for falling? A special focus on high risk patients doesn't have to shortchange others, says Pamela E. Toto, PhD, OTR/L, BCG, FAOTA, an occupational therapist at the School of Health and Rehabilitation Sciences at the University of Pittsburgh in Pennsylvania.

The highest risk patients should always get more attention to prevent falls, even when everyone else is still at risk to some degree, she says.

"If you look at the literature, I could make the argument that the majority of people in the hospital are at risk for falls," Toto says. "I could go to a nursing home and tell you that 100% of the patients are at risk for falls. But you can make them into high, medium, and low risks relative to that particular population, and that can still be useful in directing your efforts."

The extra attention to high risk patients is justified by the data that identifies risk factors, Toto says. That focused attention doesn't mean that other patients don't need the basic fall prevention efforts that can apply to anyone, such as keeping the room free of clutter and providing grab bars, she says. "We know, however, that certain patients at risk in certain ways or in certain conditions. If we know that a patient has urge incontinence, she is going to be in a hurry when she gets up, and that situation puts her at risk more than a patient without that condition," Toto says. "It's appropriate to provide more assistance and more education about that scenario even if you don't address that with everyone."

Healthcare providers are using increased knowledge about the risk factors for falls to prevent accidents in more practical and patient-friendly ways, Toto says. Rather than trying to keep patients in bed to avoid falls, the traditional approach, more hospitals are providing assistance to patients when they want to get up.

"It's not about limiting their ability to move, but rather providing them a safer way to move," Toto says.