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What They Are

The National Quality Forum (NQF) defines a fall as an unplanned descent to the floor (or extension of the floor e.g., trash can or other equipment) with or without injury to the patient.

Who's At Risk

Falls are the largest category of reported incidents in hospitals.  Hospital fall and injury rates vary due to patient population, patient risk factors, the presence of fall prevention programs and interventions, and the definition of the fall rate metric utilized by the hospital.  The strongest predictor of a fall is a previous fall.

What's At Stake

The cost of falls is expensive and contributes to increasing health care expenditures.  The CDC estimated that the cost of fall injuries for those 65 years of age and older is expected to exceed $19 billion, with $0.2 billion of those fatal falls. Falls can have serious effects on a person's ability to function as a productive member of their family, community or society. Patient falls are the second most frequent cause of harm in hospitals and are the largest category of reported incidents in hospitals.  In the Massachusetts Department of Public Health (MDPH) unintentional fall related injury report, it was reported that total charges for acute care hospital events associated with unintentional falls were over $471 million in fiscal year 2006 (MDPH, 2008). 

What Providers Are Doing to Prevent Patient Falls

Massachusetts hospitals have been leaders in addressing falls prevention. Our hospital leaders continue to encourage efforts to address this serious issue, particularly regarding falls-associated morbidity and mortality for older adults. Hospitals have collaborated on and established  Falls Prevention Programs in accordance with The Joint Commission Hospital Standards to assess the patient's risk for falls, and to implement interventions to reduce falls based on the patient's fall risk assessment.  In addition, hospital is expected to evaluate the effectiveness of fall reduction activities. Falls prevention programs include multidisciplinary predictive falls risk assessments for patients when they are first admitted to the hospital, as well as customizing falls prevention programs to meet individual patient needs.  Hospitals report serious patient falls to the Department of Public Health, and public reporting of these serious falls began in 2009. Every Massachusetts hospital is also voluntarily collecting falls data through the National Quality Forum's Nursing Sensitive Indicators of Falls and Falls with Injury.  This data has been publicly reported since the summer of 2007.

MHA, in partnership with the Organization of Nurse Leaders (ONL) Practice Committee, has added extensively to falls prevention knowledge by researching and sharing best practices regarding this key quality indicator among hospitals throughout the state and by posting on the PatientCareLink and ONL websites.


Heywood Hospital Addresses Falls with Injury

Falls in hospitals happen.  Recognizing the issue, the Joint Commission has stepped in to require hospitals to implement falls-reduction programs as a requirement of accreditation, and the Centers for Medicaid and Medicare Services will no longer reimburse hospitals for the cost of care that results from inpatient falls.  Heywood Hospital in Gardner, Mass. - a 134 bed community hospital - has assembled a team to deal with the falls issue, which at Heywood is made even more difficult ty the presence of an in-facility geriatric psychiatric unit.



It's Older Americans Month!
This year's theme is Safe Today. Healthy Tomorrow. Did you know that more than 21,700 older adults die from falls each year, and every 15 seconds, an older adult is seen in an emergency room for a fall-related injury? Let's reduce those numbers together! Share our falls prevention tips and resources
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Massachusetts Commission on Falls Prevention Phase 1: The Current Landscape

Prepared by: Kim Kronenberg, Consultant to JSI Research & Training Institute, Inc. September 2013

Falls and fall-related injuries impose a significant public health burden on Massachusetts' older residents and on the health care system that treats them. In the Commonwealth, falls are the leading cause of injuries and injury deaths for people 65 years and older. These numbers are rising. This is both independent of and compounded by the fact that the population most at risk for falls (those 65 years and older) is also growing in number. Traumatic brain injuries, broken hips, loss of independence and death are some of falls' most serious outcomes. Falls are costly to the state. In 2010 in Massachusetts, total acute care hospital charges associated with older adult fall-related injuries totaled approximately $630 million. Moreover, the lifetime medical and work loss cost of the fall injuries among Massachusetts older adults that were sustained in 2010 is estimated to be over $8.5 billion.



Fall- Related Injuries and Deaths Among Older MA Adults:  2002 - 2010

Injury Surveillance Program, Bureau of Health Information, Statistics, Research & Evaluation - MA Department of Public Health, August 2013

Falls are a leading cause of injury and death across the United States and in Massachusetts and account for a significant portion of health care dollars spent on injury-related care. This bulletin focuses on unintentional falls among older Massachusetts adults ages 65 and over, as they have much higher rates of fall-related injury and death than those under age 65. Annually older adults account for 84% of all fall related deaths and 68% of all hospital stays for fall-related injuries.



Implementation Guide for Fall Injury Reduction

2010 AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons

Source: The American Geriatrics Society


The Patient Who Falls: "It's Always a Trade-off"

Mary E. Tinetti, MD; Chandrika Kumar, MD

ABSTRACT>>Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Using the case of an older man who has experienced multiple falls and a hip fracture, this article, which focuses on community-living older adults, addresses the consequences and etiology of falls; summarizes the evidence on predisposing factors and effective interventions; and discusses how to translate this evidence into patient care. Previous falls; strength, gait, and balance impairments; and medications are the strongest risk factors for falling. Effective single interventions include exercise and physical therapy, cataract surgery, and medication reduction. Evidence suggests that the most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors. Vitamin D has the strongest clinical trial evidence of benefit for preventing fractures among older men at risk. Issues involved in incorporating these evidence-based fall prevention interventions into outpatient practice are discussed, as are the trade-offs inherent in managing older patients at risk of falling. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice. Subscribed JAMA Users Read Complete Article (JAMA. 2010;303(3):258-266)»


Simple language and icons on bed poster, patient materials, HIT support reduce patient falls in acute care

Premier SafetyShare Newsletter, January 2011

Falls among patients over 65 were significantly reduced in four hospitals using a patient-specific fall interventions toolkit with simple text and icons on bed signs, patient handouts and staff care plans, and health information technology (HIT) support, a new study has found. The icons, signs, handouts and staff care plans were developed for all levels of literacy. 

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Falls Top Ten, Evidence Based Interventions

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HRET's Falls Change Package - Falls with Injury Change Package Preventing Harm from Falls

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Eliminate Harm Across the Board - HRET's Falls Poster

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Strategies in Managing and Reducing the Use of Patient Sitters


Joint Commission Urges Americans to 'Speak Up' to Prevent Falls

The new Speak Up™ campaign offers tips and actions that will help people reduce the risk of falling, whether at home or in a medical facility. Among the topics are:
taking care of your health, taking extra precautions, making small changes to your home, and taking extra precautions in the hospital or nursing home.

Read Press Release »