D219 Task 1 Evidence-Based Practice: Fall Prevention in Hospitals

Evidence-Based Practice and Applied Nursing Research: Hospital Fall Prevention

Clinical Practice Problem: Hospital Falls

Hospital-acquired falls continue to represent a serious patient safety concern within healthcare organizations. These events frequently lead to preventable injuries such as fractures, head trauma, and functional decline, which may significantly prolong hospitalization and negatively affect patient quality of life. In addition to physical harm, falls undermine patient confidence in healthcare systems and contribute to increased morbidity and mortality rates. LeLaurin and Shorr (2019) reported that nearly one million patient falls occur annually in U.S. hospitals, resulting in approximately 250,000 injuries and more than 11,000 deaths. These statistics underscore the magnitude of the problem and emphasize the need for systematic prevention efforts.

The financial implications of hospital falls further reinforce the urgency of addressing this issue. According to the Centers for Disease Control and Prevention (CDC, 2021), fall-related medical expenditures in the United States reached nearly $50 billion in a single year. These costs encompass acute treatment, extended inpatient stays, rehabilitation services, and long-term care needs. Consequently, healthcare institutions must prioritize evidence-based fall prevention strategies to enhance patient safety outcomes while simultaneously reducing avoidable healthcare spending.

Identify the PICO Components

Evidence-Based Practice (EBP) Question

In hospitalized patients who are identified as being at risk for falls (P), how effective is structured fall prevention education (I) when compared with limited or absent fall prevention education (C) in reducing or preventing fall occurrences (O)?

This EBP question aims to evaluate whether patient-centered educational interventions can serve as an effective strategy for minimizing fall events, thereby improving inpatient safety and clinical outcomes.

Research Article

Citation

de Freitas Luzia, M., Vidor, I. D., da Silva, A. C. F. E., & de Fátima Lucena, A. (2020). Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Applied Nursing Research, 54. https://doi.org/10.1016/j.apnr.2020.151273

Background and Introduction

The study conducted by de Freitas Luzia et al. (2020) examined the effectiveness of nursing-driven interventions in reducing fall risk among hospitalized patients identified as high risk. The researchers utilized the Nursing Outcomes Classification (NOC) framework to evaluate patient knowledge, behaviors, and engagement related to fall prevention. Emphasis was placed on the nurse’s role in patient education and care planning, recognizing nurses as key contributors to continuous risk assessment and safety promotion. By aligning interventions with standardized nursing outcomes, the study highlighted how structured education can strengthen patient participation in fall prevention efforts.

Methodology

This investigation employed a quantitative cross-sectional design and included adult patients aged 17 years and older who were classified as high risk for falls. Participants were recruited from both medical and surgical units to enhance population variability and applicability.

Based on the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this study represents Level II evidence, reflecting a strong design with reliable outcome measurement.

Data Analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Correlational analyses, including Pearson and Spearman tests, were conducted to evaluate relationships between patient knowledge and preventive behaviors. Independent t-tests and Generalized Estimating Equations (GEE), followed by Post Hoc Least Significant Difference (LSD) testing, were applied to assess changes over time. This analytical approach ensured accurate interpretation of intervention effectiveness.

Ethical Considerations

Institutional review board approval was obtained prior to data collection. All participants provided informed consent, and ethical standards related to confidentiality, voluntary participation, and patient autonomy were strictly maintained throughout the study.

Quality Rating

The study received a Quality B rating, indicating solid methodological rigor with minor limitations. One limitation involved the exclusion of patients with cognitive impairment, which may restrict the generalizability of the findings to all hospitalized populations.

Analysis of Results and Conclusions

Initial findings demonstrated that patients possessed limited baseline knowledge regarding fall prevention strategies. Following educational interventions, significant improvements were observed in patient awareness, safety behaviors, and adherence to preventive measures. The authors concluded that ongoing nursing education and the use of standardized frameworks such as NOC are effective in reducing fall risk and promoting safer inpatient environments.

Alignment to the EBP Question

This research directly addresses the EBP question by demonstrating that structured fall prevention education significantly reduces fall risk among hospitalized patients, supporting education as an essential component of patient safety initiatives.

Non-Research Article

Citation

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Background and Introduction

Heng et al. (2020) conducted a scoping review to examine the role of patient education in hospital fall prevention. The review synthesized findings from multiple studies and evaluated how educational interventions influence patient engagement, safety behaviors, and fall outcomes. The authors emphasized that effective education must be individualized, theory-driven, and reinforced throughout hospitalization to support sustained behavioral change.

Type and Level of Evidence

Author’s Recommendations

The authors recommended implementing patient education programs grounded in cognitive and behavioral learning theories. Strategies such as visual aids, interactive teaching sessions, and repeated reinforcement were identified as critical to improving knowledge retention and adherence to fall prevention strategies.

Alignment to the EBP Question

This scoping review strongly supports the EBP question by confirming that patient education plays a central role in reducing inpatient falls. When education is structured and patient-centered, it significantly enhances safety outcomes.

Recommended Practice Change

The proposed practice change involves implementing a comprehensive fall prevention education program for patients identified as high risk. Education should be delivered consistently by bedside nurses and reinforced using evidence-based tools such as visual materials and demonstrations. Findings from both de Freitas Luzia et al. (2020) and Heng et al. (2020) indicate that informed patients are more likely to engage in preventive behaviors and contribute to a culture of shared safety responsibility.

Key Stakeholders

Barriers to Implementation

Implementation challenges may include limited financial resources, staffing shortages, time constraints, and resistance to practice change. Additionally, nurse fatigue and competing clinical demands may reduce engagement with new educational initiatives.

D219 Task 1 Evidence-Based Practice: Fall Prevention in Hospitals

Strategies to Overcome Barriers

Indicator to Measure the Outcome

Program effectiveness should be evaluated by comparing fall rates before and after implementation using hospital quality improvement data. A measurable reduction in fall incidents among high-risk patients will indicate successful intervention outcomes.

References

Centers for Disease Control and Prevention. (2021, August 6). Facts about falls. https://www.cdc.gov/falls/facts.html

de Freitas Luzia, M., Vidor, I. D., da Silva, A. C. F. E., & de Fátima Lucena, A. (2020). Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Applied Nursing Research, 54. https://doi.org/10.1016/j.apnr.2020.151273

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007