Hospital falls are a frequent sentinel event worldwide, yet prevention remains challenging. There is a need to standardize hospital fall management in healthcare facilities. This study aimed to analyze policies and procedures used by Italian healthcare facilities to reduce hospital falls.
Methods
The Italian hospitals’ public procedures on patients’ falls issued between November 2011 and June 2022 were retrieved by a web search using the Google search engine and further evaluated according to their compliance with the 2011 Italian Ministerial recommendation for the prevention of patients’ falls.
Results
We found 37 official online procedures, of which 45.6% showed full compliance with the 2011 Ministerial recommendation. All the documents explicitly addressed the issue of identifying patient-related fall risk profiles, whereas 28 set appropriate environmental risk factors. More than 80% of the retrieved procedures used the Conley scale. Forty-three percent of the procedures did not provide for national monitoring and reporting of patient falls.
Conclusions
Public procedures for preventing patient falls in Italian hospitals are scarcely compliant with the 2011 Ministerial recommendation. Local monitoring, compliance, and reporting of hospital falls are needed to improve patient outcomes and reduce the risk of litigation for staff and organizations. Additionally, standardized tools for evaluating the risk of falls, healthcare professionals’ training, and implementing environmental prevention strategies are needed to contrast this issue.
ParkSH. Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clin Exp Res2018; 30(1): 1–16.
3.
CallisN. Falls prevention: identification of predictive fall risk factors. Appl Nurs Res2016; 29: 53–58.
4.
HaagsmaJAOlijBFMajdanM, et al.Falls in older aged adults in 22 European countries: incidence, mortality and burden of disease from 1990 to 2017. Inj Prev2020; 26(Supp 1): i67–i74.
5.
Montero-OdassoMVan Der VeldeNMartinFC, et al.World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing2022; 51(9): afac205.
6.
JamesSLLucchesiLRBisignanoC, et al.The global burden of falls: global, regional and national estimates of morbidity and mortality from the global burden of disease study 2017. Inj Prev2020; 26(Supp 1): i3–i11.
7.
YePErYWangH, et al.Burden of falls among people aged 60 years and older in mainland China, 1990–2019: findings from the Global Burden of Disease Study 2019. Lancet Public Health2021; 6(12): e907.
HuangJWLinYYWuNY,et al.Rural older people had lower mortality after accidental falls than non-rural older people. Clin Interv Aging2017; 12: 97.
10.
HaasumYJohnellK. Use of antiepileptic drugs and risk of falls in old age: a systematic review. Epilepsy Res2017; 138: 98–104.
11.
FalcãoRdMCostaKdFFernandesMdG, et al.Risk of falls in hospitalized elderly people. Rev Gaucha Enferm2019; 40: e20180266.
12.
SchoeneDKiesswetterESieberCC,et al.Musculoskeletal factors, sarcopenia and falls in old age. Z Gerontol Geriatr2019; 52: 37–44.
13.
SwiftCGIliffeS. Assessment and prevention of falls in older people - concise guidance. Clin Med, J of the R College of Phys of London2014; 14: 658–662.
14.
A, YoungJIliffeSRikkertMO, et al.Frailty in elderly people. Lancet2013; 381: 752–762.
15.
FriedLPTangenCMWalstonJ, et al.Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci2001; 56(3): M146–M156.
16.
WilliamsonJ. Bernard Isaacs. The Challenge of Geriatric Medicine. Oxford; Oxford University Press, 1992, 244 pp.
17.
JamesSLLucchesiLRBisignanoC, et al.The global burden of falls: global, regional and national estimates of morbidity and mortality from the global burden of disease study 2017. Inj Prev2020; 26(Supp 1): i3–i11.
18.
DykesPCCurtin-BowenMLipsitzS, et al.Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program. JAMA Health Forum2023; 4(1): E225125.
19.
TinettiMEWilliamsCS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci1998; 53(2): M112–M119.
20.
MasudTMorrisRO. Epidemiology of falls. Age Ageing2001; 30(SUPPL. 4): 3–7.
21.
HillAMMcPhailSMWaldronN, et al.Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet2015; 385: 2592–2599.
22.
SchobererDBreimaierHEZuschneggJ, et al.Fall prevention in hospitals and nursing homes: clinical practice guideline. Worldviews Evid Based Nurs2022; 19: 86–93.
23.
HainesTKuysSSMorrisonG, et al.Balance impairment not predictive of falls in geriatric rehabilitation wards. J Gerontol A Biol Sci Med Sci2008; 63: 523–528.
24.
NajafpourZGodarziZArabM,et al.Risk factors for falls in hospital in-patients: a prospective nested case control study. Int J Health Policy Manag2019; 8: 300–306.
25.
LeoneRMAdamsRJ. Safety standards: implementing fall prevention interventions and sustaining lower fall rates by promoting the culture of safety on an inpatient rehabilitation unit. Rehabil Nurs2016; 41: 26–32.
26.
MorelloRTBarkerALHainesT, et al.In-hospital falls and fall-related injuries: a protocol for a cost of fall study. Inj Prev2013; 19: 363.
27.
HengHJazayeriDShawL, et al.Hospital falls prevention with patient education: a scoping review. BMC Geriatr2020; 20(1): 140.
28.
StriniVSchiavolinRPrendinA. Fall risk assessment scales: a systematic literature review. Nurs Rep (Pavia, Italy)2021; 11: 430–443.
29.
MorrisMEWebsterKJonesC, et al.Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing2022; 51(5): afac077
30.
TurnerKStaggsVSPotterC, et al.Fall Prevention Practices and Implementation Strategies: Examining Consistency Across Hospital Units. J Patient Saf2022; 18(1): E236–E242.
31.
OliverDBrittonMSeedP, et al.Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. Br Med J1997; 315: 1049–1053.
32.
NandySParsonsSCryerC, et al.Development and preliminary examination of the predictive validity of the falls risk assessment tool (FRAT) for use in primary care. J Public Health (Oxf)2004; 26: 138–143.
33.
OliverDDalyFMartinFC,et al.Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing2004; 33: 122–130.
34.
MorrisMEHainesTHillAM, et al.Divesting from a scored hospital fall risk assessment tool (FRAT): a cluster randomized non-inferiority trial. J Am Geriatr Soc2021; 69: 2598–2604.
Ministero della Salute direzione generale della programmazione sanitaria ufficio iii ex dgprogs Protocollo di Monitoraggio degli eventi sentinella 5° Rapporto.
FerracutiSBarchielliBNapoliC, et al.Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective. Int J Psychiatry Clin Pract2020; 24: 245–249.
41.
FerracutiSBarchielliBNapoliC, et al.Managing and preventing acts of violence against health workers: results of a review evaluating hospital control procedures. J Aggress Confl Peace Res2022; 14: 100–111.
42.
AlbolinoSBellandiTCappellettiS, et al.New rules on patient’s safety and professional liability for the Italian health service. Curr Pharm Biotechnol2019; 20: 615–624.
Montero-OdassoMMKamkarNPieruccini-FariaF, et al.Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. JAMA Netw Open2021; 4(12): e2138911.
46.
LettsLMorelandJRichardsonJ, et al.The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies. Aust Occup Ther J2010; 57(1): 51–64.
JohnstonMMagnanMA. Using a fall prevention checklist to reduce hospital falls: results of a quality improvement project. Am J Nurs2019; 119: 43–49.
49.
HarperKJArendtsGBartonAD,et al.Providing fall prevention services in the emergency department: is it effective? A systematic review and meta-analysis. Australas J Ageing2021; 40: 116–128.
50.
HengHKiegaldieDShawL, et al.Implementing patient falls education in hospitals: a mixed-methods trial. Healthcare (Switzerland)2022; 10(7): 1298.
51.
HengHKiegaldieDSladeSC, et al.Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study. PLoS One2022; 17(4): e0266797.
52.
ShawLKiegaldieDHengHMorrisME. Interprofessional education to implement patient falls education in hospitals: Lessons learned. Nurs Open2023; 10(1): 36–47.
53.
MckercherJPSladeSCJazayeriJA, et al.Patient experiences of codesigned rehabilitation interventions in hospitals: a rapid review. BMJ Open2022; 12: 68241.
54.
CiofiDAlbolinoSDaglianaG, et al.Prevalence and multicenter observational study on falls of hospitalized children and Italian, linguistic-cultural validation of the humpty dumpty fall scale. Prof Inferm2020; 73: 296–304.
55.
JewellVDCapistranKFleckyK, et al.Prediction of falls in acute care using the morse fall risk scale. Occup Ther Health Care2020; 34: 307–319.
56.
MatareseMIvzikuDBartolozziF, et al.Systematic review of fall risk screening tools for older patients in acute hospitals. J Adv Nurs2015; 71: 1198–1209.
57.
PellicciariLPiscitelliDCaselliS, et al.A Rasch analysis of the Conley scale in patients admitted to a general hospital. Disabil Rehabil2019; 41: 2807–2816.
58.
MorelloRTSohSEBehmK, et al.Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis. Inj Prev2019; 25: 557–564.
59.
AngGCLowSLHowCH. Approach to falls among the elderly in the community. Singapore Med J2020; 61: 116–121.
60.
KendrickDKumarACarpenterH, et al.Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev2014; 2014(11): CD009848.
61.
ZipperSG. Medical risk management. Med Klin (Munich)2006; 101(10): 796–803.
62.
GuzzoASTeccaMMarinelliE, et al.Quality assessment of medical records as a tool for clinical risk management: a three year experience of a teaching hospital policlinico umberto I, Rome. Sens Sci2017; 4: 371–379.
