What Are Falls?
Falls are the primary cause of unintentional injuries among older Australians, defined as incidents where an individual unintentionally ends up on the ground, floor, or a lower level. Older adults must discuss all falls, including those without injury, with their general practitioners or other healthcare providers to identify and address underlying factors (Department of Health 2021).
Who is Most at Risk of Falling
Older people living in aged care facilities or admitted to acute care settings experience falls more frequently (Clinical Excellence Commission, 2023). One-third of individuals aged 65 or older experience at least one fall annually, with many falling more regularly. Consequences of falls include bone fractures, head injuries, reduced quality of life and fear of falling (Sherrington, Fairhall, Kwok, Wallbank et al. 2020).
What Causes Falls in Older Adults?
There are many reasons why older people fall. Below are just some of the reasons why a person would fall. In the list below, you will be able to identify learning opportunities you can assign to your staff that focus on falls prevention as an isolated activity and how it relates to clinical practice scenarios. Risk factors include:
- History of falls
- Medicines
- Nutrition
- Continence issues
- Frailty
- Comorbidities such as cardiac conditions, renal conditions, and diabetes
- Cognitive impairment
- Not wearing glasses or hearing aids
- Cluttered environments
- Osteoporosis
- Footwear
- Restraint
All healthcare facilities must consider these risk factors and implement preventative measures to ensure injury does not occur.
Why is Falls Prevention Important in Healthcare so Important?
Falls prevention is critical because all falls are preventable. Falls are commonly associated with increased length of hospital stay, increased mortality rates, and earlier-than-expected admission into aged care. The human cost to the older person and their family following a fall incident is equally significant (Clinical Excellence Commission 2023).
It is important to note that fall injuries cost the healthcare system a lot of money annually. For example, in 2021, the cost to the NSW health system from falls by older people in the community was approximately $752 million. These costs are set to increase to $1.09 billion by 2041 (AIHW 2023).
What is the Falls Prevention Training Requirement?
In health, aged, and community care settings, all staff must be vigilant in preventing falls among residents to ensure their safety and well-being. Therefore, it is essential for anyone working in a Learning and Development (L&D), Quality, or Education team to be familiar with regulatory requirements and to effectively meet education and training needs. Falls prevention is not just a regulatory requirement but also demonstrates best practice. The NSQHS explains that implementing comprehensive falls prevention strategies ensures consistency with the current standards.
Relevant Standard
In line with NSQHS standards, particularly the Comprehensive Care Standard, healthcare organisations must implement appropriate training programs targeting falls prevention:
Relevant Standard
Action 5.24: Regularly educate healthcare providers.
This action calls for healthcare organisations to regularly educate and train their healthcare providers on falls risk assessment and prevention. The educational programmes should cover the identification of risk factors, preventative measures, and the correct procedures to follow if a fall occurs. Training can take various forms including workshops, online modules, and practical exercise
Action 5.25: Screen and assess fall risks during admission and routinely.
Healthcare providers are required to screen all patients for their risk of falling upon admission and throughout their stay, especially after any change in medication or clinical status. This involves using standardised risk assessment tools and scales to quantify the risk of falls. Healthcare staff should be trained in utilising these tools effectively.
Action 5.26: Implement and monitor effective prevention strategies.
This action specifies that once risks are identified, evidence-based prevention strategies should be developed and implemented. This includes multifactorial interventions such as adjustments to the physical environment, optimisation of medication, and patient education. Staff should be trained on how to implement these strategies and routinely monitor their effectiveness.
National Safety and Quality Health Service (NSQHS) Standards
Action 5.5.4: Falls management processes
The provider implements processes to minimise falls and harm from falls by:
- a. maximising mobility to prevent functional decline
- b. delivering effective and timely post falls care when required
- c. monitoring falls and injuries and review the reason for and consequences from falls
The strengthened Aged Care Quality Standards - Aged Care Quality Standards
How Can Exercise Prevent Falls in Healthcare
Studies have shown that when older people engage in regular strength training exercises, it significantly reduces the risk of falls (Sherrington, Fairhall, Kwok, Wallbank et al. 2020). Falls are a significant issue in Australian healthcare settings, with approximately 77% of hospitalisations among people over 65 (Australian Institute of Health and Welfare, 2020). Ultimately, we all want to be fit and healthy when we get older, which will require encouragement and support for most of us. L& D Managers are crucial in implementing falls prevention initiatives. It is an opportunity for you to reach out and collaborate with staff and interdisciplinary teams and highlight the importance of exercise as a fall prevention strategy. Exercise programs should include some of the following areas:
- Joint mobility exercises
- Walking outdoors
- Stretching (for muscle and joint flexibility)
- Strength training
Why are Medicines a Risk Factor?
Medications affecting the central nervous system are closely associated with an increased risk of falls. Staff should be proficient in identifying, escalating, and communicating concerns regarding medication charts. Deprescribing, when it is safe to do so, is essential to reducing the risk of falls in older adults (Queensland Health 2022).
As an L&D Manager, your role is to ensure that all staff receive the required training and education to understand and apply practical, evidence-based falls prevention practices. Everyone must be engaged and dedicated to maintaining the safety and well-being of our patients, residents, and health workers.
How Can You Prevent Falls in Your Workplace Through Effective Education?
Over the years, education has been used as a standalone intervention or as part of a multifaceted approach in numerous falls prevention programs. Equipping your staff with the essential knowledge, skills, and attitudes is imperative to provide safe and effective care. Understanding the most effective methods for structuring and delivering staff education on falls prevention in your facility is crucial. Firstly, determine your staff's attitudes and learning behaviours; is a formal learning environment more suitable than short, quick micro-learning opportunities throughout one's shift? Are your allied health professionals best suited to deliver the training to your staff rather than employing an external trainer?
Encourage staff to share knowledge and experiences related to falls prevention. This empowers employees and creates a proactive, prevention-focused environment. Select appropriate job roles, teams, or individuals based on validated data and precise needs. This approach goes beyond simple compliance, fostering a workforce engaged in falls prevention practices.
How to Implement a Successful Falls Prevention Program in Your Workplace
With over 15 years of nursing experience in various leadership roles, primarily in acute care, I've witnessed many organisational initiatives come and go quickly. One successful example is a falls prevention initiative that not only reduced falls within the organisation and prioritised patient safety but also improved the learning culture and related behaviours.
‘Ruby Red Socks’ Falls Prevention hit the ground running in my workplace in 2010 with Steven Bradbury, the Olympic gold medalist, as the ambassador of the Falls Prevention Program. The non-slip Ruby Red Socks were designed by a physiotherapist. Unlike a typical in-hospital falls prevention program, the Ruby Red Socks Program focused on empowering staff, patients, friends and family to actively reduce the risk of serious injuries while in hospital.
The Ruby Red Socks Campaign was alive, signage, flyers, pens and stickers saturated the hospital foyer and wards of the hospital. The hospital was vibrant, and the staff were excited about the activities surrounding the launch. Frequent morning teas were often hosted by the CEO and Director of Nursing. Short, sharp briefing sessions ran every day for months to ensure all staff were informed about the program and the activities that would take place over the coming months. The project promoted learning from mistakes, rewards for safety efforts, and supported a blame-free environment. The leadership team did a great job at presenting falls data in a way that was easily digestible and put patient safety at the centre.
The project's success stemmed from building a positive safety culture towards falls prevention and forming multidisciplinary teams purely focused on falls prevention. These teams included a lead from the falls prevention program, often a person who has undergone formal training in falls, a nurse, and a member of the allied health team. The multidisciplinary approach provided a holistic view of each patient's risk factors, ensuring that all potential issues were addressed comprehensively.
The benefit of having these teams throughout the organisation was to ensure staff felt supported. By having falls prevention teams distributed throughout the hospital, staff received better training, leading to improved competence and confidence in preventing falls. Training sessions included various topic areas such as identifying falls risk factors, reporting falls, risk assessment and screening tools, best-practice prevention strategies, and footwear. Increasing awareness of falls risk with the assistance of representatives led to higher compliance and competence, resulting in a decrease in falls.
How Staff Should Respond to Falls in the Workplace
Staff in health facilities play a crucial role in responding to falls. After a fall, it is essential for staff to review the incident, complete a falls incident report, and provide recommendations for immediate and long-term care. Gathering information about the circumstances of the fall may require input from various people, including staff, visitors, and other residents. To prevent future falls, staff should determine how and why the fall occurred using checklists and practice guidelines provided by the care facility (ACSQH 2009 & South Eastern Sydney Local Health District, 2022).
Secondly, managers must conduct a root-cause analysis for serious falls, mainly if they result in severe injury or death, and report them to the state coroner in some jurisdictions. A culture of accurate and non-punitive reporting is vital for effective falls management. Leaders should encourage incident reporting as part of quality improvement rather than a punitive measure. Continuous feedback on falls data should be provided to staff to illustrate trends and inform practice changes aimed at reducing falls. Residents who fall repeatedly or suffer from a fall that has caused an injury will require comprehensive assessments and may need referrals to specialists or falls clinics. Post-fall, staff should monitor residents for changes in activity levels or increased fear of falling, a familiar feeling people report. Support the person through balance and mobility training programs and other prevention activities (ACSQH 2009 & South Eastern Sydney Local Health District, 2022).
How to Assess Staff Competency in Falls Prevention
Health staff should be encouraged to undertake self-assessment exercises that test their knowledge and practical skills in falls prevention.
- Self-assessments:
Self-assessment is when health workers evaluate their skills and knowledge to identify strengths and areas for improvement. This process helps maintain high standards of care by highlighting where more learning or support is needed. They can use surveys, reflection journals, peer feedback, self-assessment tools, and case reviews to perform self-assessments. - Peer reviews:
Peer assessment can also provide invaluable insights into the competency of healthcare providers. Structured forms or online platforms can be used to collect peer feedback on an individual’s falls prevention practices. - Direct observation:
Clinical leaders, falls prevention champions, or external educators should observe staff during their shifts. By working alongside staff and offering assistance, they can understand how staff assess, implement, and document fall prevention strategies. - Key performance indicators:
Use key performance indicators (KPIs) specific to falls prevention to measure healthcare providers' performance over time. This can include tracking the number of falls and near-misses. Benchmarking performance is also important as it drives continuous improvement within your organisation. - Continuing Education:
Track the ongoing education and training activities undertaken by healthcare providers in the area of falls prevention. Continuing education is a strong indicator of commitment to professional development and competency.
What Skills Do Staff Need to Learn Falls Prevention Skills?
| Skill | Key Elements |
|---|---|
| Risk assessment |
Staff should be proficient in using standardised tools to assess a patient's risk of falling. This includes understanding factors like medical history, medication, and physical condition. |
| Communication |
Communication skills are vital to ensure that all members of the healthcare team, as well as the person and their families, are informed about the risks and prevention strategies. Staff should be able to articulate complex medical terms in a manner that is easily understood by all parties involved. |
| Observation |
Staff must have sharp observational skills to detect changes in a patient's condition, behaviour, and environment that could increase the risk of falls. |
| Environmental safety |
Skills in identifying and mitigating environmental hazards, such as clutter, poor lighting, and slippery floors, to create a safer living environment. |
| Technical skills |
Knowledge and proficiency in selecting and correctly using mobility aids, such as walkers, canes, and wheelchairs, to support the individuals mobility and reduce falls risk. |
| Critical thinking |
Decision-making: These include the correct use of mobility aids, assistive devices, and fall prevention equipment like anti-slip mats and hip protectors. Prioritisation: Evaluating the severity of falls and determining the urgency of medical attention or changes in care plans, prioritising actions that will most effectively reduce risk. Anticipation and planning: Proactively identify potential future risks and plan appropriate interventions to prevent falls rather than react after incidents occur. Continuous improvement: Applying a mindset of ongoing learning and improvement, using feedback and new evidence to refine practices and enhance the overall safety of the care environment. |
| Incident reporting |
Staff should know the correct protocols to follow when a fall occurs, including medical intervention, documentation, and incident reporting. |
By supporting staff in developing these skills, you will better equip them to engage in, learn from, and apply best-practice falls prevention within your organisation.
Strategies to Support Employees in Improving Care for Falls Prevention
Building competency in diversity and high-risk group, care must involve a multi-faceted approach. Below are some strategies to help support employees in this area:
- Access to online resources:
Provide staff with access to reputable online courses, journals, and guidelines. Access to digital resources allows for continuous learning, making it easier for staff to stay updated on falls prevention. - Interdisciplinary Team Meetings:
Falls prevention is not just the responsibility of nurses or doctors but involves a multidisciplinary approach. Regular meetings across departments, including physiotherapists, occupational therapists, and pharmacists, can help in the exchange of ideas and update everyone on the latest prevention protocols. - Debrief sessions:
Hold a debriefing session whenever a fall occurs to discuss the incident, including its emotional impact, ways to support staff and families, identify areas for improvement, and celebrate what was handled well.
Sample Training Plan for the Falls Prevention Requirement
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Using the above image as an example - The results that require immediate attention are "risk assessment skills", "technical skills", and "incident reporting".
Based on this, we can develop a training plan to develop staff's skills in these areas off falls prevention. Below is a sample training plan that can be adapted to your organisation's specific needs.
| Quarter | Topics | Resources |
|---|---|---|
| Q1 | Risk assessment |
|
| Q2 | Technical skills | |
| Q3 | Incident reporting |
Competency Assessment for Falls Prevention - Example
Surveys provide a quick and effective method for gathering data on staff confidence in specific clinical practice areas. The following example can help you get started.
Staff Survey - Falls Prevention Competency
-
How frequently should falls risk assessment be conducted?
[Write your response here]
-
List 4 main risk factors that contribute to someone falling.
[Write your response here]
-
Describe one effective falls prevention strategy.
[Write your response here]
-
How would you care for a patient who has just experienced a fall?
[Write your response here]
-
In your opinion, how effective are the current preventative measures at our facility in reducing falls
Very effective
Effective
Neutral
Ineffective
Very ineffective
-
How well do you feel the current training programs prepare you to implement effective falls prevention strategies?
Very well
Moderately well
Slightly well
Not well at all
Conclusion
Falls prevention is a critical aspect of healthcare, especially for older adults. The success of prevention initiatives lies in building a positive and safe learning culture. Implementing structured falls prevention programs and continuous education ensures a high standard of care. Supporting staff through ongoing training and fostering a collaborative environment enhances their ability to prevent falls and deliver high quality care.
References
- Australian Institute of Health and Welfare 2022, Falls in older Australians aged 65 and over 2019–20, Australian Government, viewed 1 July 2024, https://www.aihw.gov.au/getmedia/467fd7e8-bb5d-46b0-890d-c7235591804b/aihw-injcat-226-fact-sheet.pdf.aspx#:~:text=Falls%20accounted%20133%2C000%20hospitalisations%20and,those%20aged%2065%20and%20over.&text=from%20a%20fall%20than%20those%20aged%2015%20to%2064
- Clinical Excellence Commission 2023, Falls Prevention in NSW White Paper 2023, NSW Government 2023, viewed 1 July 2024, https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/921599/CEC_FallsWhitePaper_FINAL.pdf
- Francis‐Coad, J, Hang, JA, Etherton‐Beer, C, Ellis, A & Hill, AM 2019, ‘Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: a cross‐sectional survey’, International Journal of Older People Nursing, vol. 14, no. 2, p. e12224.
- Montero-Odasso, MM, Kamkar, N, Pieruccini-Faria, F, Osman, A, Sarquis-Adamson, Y, Close, J, Hogan, DB, Hunter, SW, Kenny, RA, Lipsitz, LA & Lord, SR 2021, ‘Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review’, The Journal of the American Medical Association Network Open, vol. 4, no. 12, pp. e2138911-e2138911.
- Shaw, L, Kiegaldie, D & Farlie, MK 2020, ‘Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review’, Boston Medical Centre of Geriatrics, vol. 20, pp. 1-13.
- South Australia Health 2024, Falls prevention for health professionals, South Australia Government, viewed 1 July 2024, https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/older+people/falls+prevention/falls+prevention+for+health+professionals
- South Eastern Sydney Local District 2022, Falls Prevention and Management: A Best Practice Guide for Allied Health Professionals, NSW Government, viewed 1 July 2024, https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDGL%20099%20-%20Falls%20Prevention%20and%20Management%20%20A%20Best%20Practice%20Guide%20for%20Allied%20Health%20Professionals.pdf
- Australian Commission on Safety and Quality in Health 2023, Preventing falls and harm from falls, National Safety and Quality Health Service Standards, viewed 26 June 2024, https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard
- Australian Commission on Safety and Quality in Health 2023, Preventing falls and harm from falls Action 5.24, National Safety and Quality Health Service Standards, viewed 26 June 2024, https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard/minimising-patient-harm/action-524
- Australian Commission on Safety and Quality in Health 2023, Preventing falls and harm from falls Action 5.25, National Safety and Quality Health Service Standards, viewed 26 June 2024, https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard/minimising-patient-harm/action-525
- Australian Commission on Safety and Quality in Health 2023, Preventing falls and harm from falls Action 5.26, National Safety and Quality Health Service Standards, viewed 26 June 2024, https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard/minimising-patient-harm/action-526
- Aged Care Quality and Safety Commission 2023, Falls and mobility Action 5.5.4, Aged Care Quality and Safety Commission, viewed 1 July 2024, https://www.health.gov.au/resources/publications/the-strengthened-aged-care-quality-standards-final-draft?language=en
- Australian Commission on Safety and Quality in Health 2010, Guidebook for Preventing Falls and Harm From Falls in Older People: Australian Residential Aged Care Facilities, viewed 1 July 2024, https://www.safetyandquality.gov.au/sites/default/files/migrated/30454-RACF-Guidebook.pdf
Author
Renee Di Giuseppe
Renee Di Giuseppe is a Critical Care Registered Nurse with over 18 years of experience. She holds a Master of Health Science (Critical Care). She has a background in critical care settings, with significant clinical and management experience working in a large intensive care unit in Melbourne.
As an Associate Nurse Unit Manager (ANUM), Renee enjoyed leading teams throughout her clinical nursing career. Renee has a great passion for nursing leadership and infused her units with a distinct culture of collaboration, respect, and accountability. Renee was a regular, well-evaluated presenter for Ausmed’s face-to-face events, specialising in presenting a 2-day seminar on recognising and responding to clinical deterioration.
In 2020, she transitioned to a non-clinical nursing career at Ausmed, building expertise in education, regulation, clinical governance and community and event management. Renee currently holds a Community Manager role within Ausmed's Marketing Team, which focuses on developing helpful and engaging content and promoting and delivering impactful live and virtual events, drawing on her expertise in presenting and coordinating Ausmed’s events to foster community engagement.
