NPSF Professional Learning Series presents:

Falls: Risk Assessment, Prevention,

and Measurement
February 28, 2013

Lea Anne Gardner, PhD, RN

Senior Patient Safety Analyst
Pennsylvania Patient Safety Authority

Michelle Feil, MSN, RN

Senior Patient Safety Analyst
Pennsylvania Patient Safety Authority
 Participant Notification
This educational activity offers 1.0 contact hours for physicians, nurses and healthcare executives.

Physicians
The Doctors Company designates this educational activity for a maximum of 1.0 AMA PRA
Category 1 Credit(s)™

This webinar activity has been planned and implemented in accordance with the Essential Areas
and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the
joint sponsorship of The Doctors Company and the National Patient Safety Foundation (NPSF).
The Doctors Company is accredited by the ACCME to provide continuing medical education for
physicians.

NPSF Professional Learning Series

 Participant Notification
This educational activity offers 1.0 contact hours for physicians, nurses and healthcare executives.

Nursing
Inquisit is accredited as a provider of continuing nursing education by the American Nurses
Credentialing Center’s COA.

Inquisit is Iowa Board of Nursing provider 333 and 1.2 contact hours will be awarded for this
program.

Executives:
Inquisit is authorized to award 1.0 hours of pre-approved ACHE Qualified Education credit for this
program toward advancement or re-certification in the American College of Healthcare Executives.
Participants in this program wishing to have the continuing education hours applied toward ACHE
Qualified Education credit should indicate their attendance when submitting application to the
American College of Healthcare Executives for advancement or recertification.

*Continuing education credits are only available for live webcasts. A post-event survey must be
completed within 7 days of participation to receive continuing education credits.

NPSF Professional Learning Series

 Disclosure
Faculty Disclosure
Lea Anne Gardner and Michelle Feil have disclosed no relevant, real or
apparent personal or professional financial relationships.

Acknowledgement of Commercial Support

There was no commercial support received for this CME activity.

NPSF Professional Learning Series

 Learning Objectives
• Identify evidence-based fall risk assessment tools used
in inpatient and outpatient settings.
• Describe how pairing fall risk assessment with mobility
tests and injury risk assessment may further contribute
to decreased falls and falls with injury.
• Plan a standardized approach to implementing
evidence-based prevention strategies for patients
identified at risk to fall, targeted to identified risk factors.
• Outline methods for measuring processes and outcomes
related to inpatient and outpatient falls.

NPSF Professional Learning Series

NPSF Professional Learning Series presents:
Falls: Risk Assessment, Prevention,
and Measurement
February 28, 2013

Lea Anne Gardner, PhD, RN

Senior Patient Safety Analyst
Pennsylvania Patient Safety Authority

Michelle Feil, MSN, RN

Senior Patient Safety Analyst
Pennsylvania Patient Safety Authority
Falls Risk Assessment: A Foundational Element of Falls Prevention Programs
http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Sep;9(3)/P
ages/73.aspx

NPSF Professional Learning Series

 Best Practices in
Falls Risk Assessment

NPSF Professional Learning Series

Risk Assessment

NPSF Professional Learning Series

Risk Assessment
• “I think that we have to be constantly asking ourselves,
'How do we calculate the risk?' And sometimes we don't
calculate it correctly; we either overstate it or understate
it.” – Hillary Clinton

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NPSF Professional Learning Series

Falls Risk Assessment
• Assess patients for their falls risk:
▫ On admission
▫ Upon transfer from one unit to another
▫ With any status change
▫ Following a fall
▫ At regular intervals

In other words…
Perform Risk Assessment, Re-Assessment and
Postfall Assessment

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NPSF Professional Learning Series

Joint Commission
• 2005 National Patient Safety Goal “reduce the risk of patient
harm resulting from falls”
▫ Initial assessment of falls risk
▫ Periodic reassessments
• 2010 incorporated as a standard with two elements of
performance
▫ Assess and manage the patient’s risks for falls
▫ Implement interventions to reduce falls based on the patient’s
assessed risk

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NPSF Professional Learning Series

Joint Commission, cont’d.
Root Cause Information for Falls-related Events
Reviewed by The Joint Commission
(Resulting in death or permanent loss of function)
2004 – 1Q 2012 (N=477)
The majority of events have multiple root causes
Assessment
400 Leadership
Communication
300
Human Factors
200 Physical Environment
Care Planning
100 Information Management
Continuum of Care
0
Falls by root cause Patient Education

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NPSF Professional Learning Series

Risk Assessment Tools
• Risk assessment tools by themselves do not prevent
patient falls - they predict them

Sensitivity
The ability of the tool to identify positive results
A high score identifies most of the patients who
go on to fall
Specificity
The ability of the tool to identify negative results
A low score identifies most of the patients who do
not go on to fall

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NPSF Professional Learning Series

Risk Assessment Tools
What’s the Evidence?
• Sensitivity and specificity can vary greatly between tools
• Risk assessment tools with high sensitivity and specificity
assess:
▫ Gait instability
▫ Lower extremity weakness
▫ Agitated confusion
▫ Urinary incontinence/frequency
▫ Falls history
▫ Prescription of ‘culprit’ drugs (especially sedative/hypnotics)

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NPSF Professional Learning Series

Risk Assessment Tools
What’s Out There?

• Morse
• Hendrich I & II
• STRATIFY
• Johns Hopkins
• Conley
• Innes
• Downton
• Tinetti
• Schmid

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NPSF Professional Learning Series

 Falls Risk Assessment Tools
COMPARISON OF VARIABLES ASSESSED BY FALL RISK ASSESSMENT TOOLS
MORSE HENDRICH II JOHNS HOPKINS
History of falls X X
Gait instability X X X
Lower extremity weakness
Altered mental status X X X
Altered elimination X X
High risk medications X X
Secondary diagnosis X
Ambulatory aid X X
IV/heparin lock X
Dizziness/vertigo X X
Depression X
Male gender X
Advanced age X
Automatic low or high risk triggers X
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SENSITIVITY 78 74.9 Not tested

NPSF Professional Learning Series
SPECIFICITY 83 73.9 Not tested
Pediatric Risk Assessment Tools
• Pediatric Falls Risk Assessment Tools
▫ Schmid “Little Schmidy”
▫ CHAMPS
▫ General Risk Assessment for Pediatric
Inpatient Falls (GRAF PIF)
▫ Humpty Dumpty
▫ I’M SAFE

http://www.ajj.com/services/pblshng/pnj/ce/2011/article35227231.pdf

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NPSF Professional Learning Series

Outpatient Risk Assessment Tools
• History of falls
• Get Up and Go
• Timed Get Up and Go

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NPSF Professional Learning Series

Risk Assessment Tools
• Each hospital should test for internal validity
• A good tool would have limited false negatives
• These tools may be paired with
 A mobility test (Get Up and Go)
 Injury risk assessment (ABCs)

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NPSF Professional Learning Series

Mobility Tests
• Timed Up and Go (TUG)
▫ Observe patient rise from a chair,
ambulate three meters, turn, return
to the chair, and sit
▫ Greater than 14 seconds predicts
falls (sensitivity and specificity
greater than 87%)

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NPSF Professional Learning Series

 Mobility Tests
• Get Up and Go
▫ Similar test, longer in length
• Hendrich II includes one element from Get Up and
Go: observing a patient rise from a chair with
hands on the thighs
▫ Rises in single attempt but must use hands to push up
[Odds Ratio (OR) for falling = 2.16]
▫ Uses hands, requires multiple attempts (OR = 4.67)
▫ Unable to rise (OR = 10.06)

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NPSF Professional Learning Series

 Assessing Risk of Injury
• Use the ABCs to identify patients with the
highest risk of falls with injury:
▫ Age – age 85 or older
▫ Bones – osteoporosis, previous fracture,
prolonged steroid use, bone metastases

▫ Coagulation abnormalities – anticoagulants, bleeding disorders,

conditions causing coagulopathy

▫ Surgery – recent limb amputation, or major abdominal or thoracic

surgery

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NPSF Professional Learning Series

Screening and Risk Assessment
• Falls risk assessment is a multi-step process
1. Screening using a risk assessment tool
2. In-depth multifactorial risk assessment

Risk assessment does not end with

administration of the screening tool

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NPSF Professional Learning Series

24
 Individual Falls Risk Factors
FALLS RISK FACTORS WITH CORRESPONDING MEAN RELATIVE RISK
RISK FACTOR MEAN RELATIVE RISK RATIO (RANGE)
Muscle weakness 4.4 (1.5-10.3)
History of falls 3.0 (1.7-7.0)
Gait deficit 2.9 (1.3-5.6)
Balance deficit 2.9 (1.6-5.4)
Use of assistive device 2.6 (1.2-4.6)
Visual deficit 2.5 (1.6-3.5)
Arthritis 2.4 (1.9-2.9)
Impaired activities of daily living 2.3 (1.5-3.1)
Depression 2.2 (1.7-2.5)
Cognitive impairment 1.8 (1.0-2.3)
25
Age over 80 1.7 (1.1-2.5)
Rubenstein
NPSF LZ, Learning
Professional Josephson KR. The
Series epidemiology of falls and syncope.
Clinics in Geriatric Medicine 2002;18:141-158.
Profile of a Hospitalized Patient
at Risk for Falls
• Cognitive impairment (including depression)
• History of previous falls
• Impaired mobility
• Special toileting needs
• Other contributors
▫ Advanced age
▫ Medications

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NPSF Professional Learning Series

Cognitive Impairment
• Delirium
▫ Hypoactive
▫ Hyperactive
• Dementia
• Slower cognitive processing
• Depression

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NPSF Professional Learning Series

Depression and Falls
• Twice as likely to fall as those without depression
• Observe for any of the following signs:
▫ Prolonged feelings of helplessness, hopelessness, or
being overwhelmed
▫ Tearfulness
▫ Flat affect or lack of interest
▫ Loss of interest in life events
▫ Melancholic mood
▫ Withdrawal
▫ The patient’s statement of depression

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NPSF Professional Learning Series

History of Falls

• Prior falls predict future falls

• History of falling within previous
12-month period can triple the risk
of future falls
• Different studies have used
different cut-off points

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NPSF Professional Learning Series

Impaired Mobility
• Muscle weakness
• Decreased gait speed
• Decreased stride length
• Use of assistive devices
• Arthritis
• Impairment in activities of daily living

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Special Toileting Needs
• Incontinence
• Urinary frequency
• Diarrhea
• Toileting - related falls increase the
risk of fall-related injuries by an
odds ratio of 2.4

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NPSF Professional Learning Series

Advanced Age
• 1 in 3 adults over age 65 fall each
year
• Falls are the leading cause of injury
death in adults over 65
• Adults 75 and older are four times as
likely to suffer an injurious fall than
adults ages 65 to 74
http://www.cdc.gov/homeandrecreationalsafety/fal
ls/adultfalls.html

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NPSF Professional Learning Series

Medications and Falls Risk
• 4 or more medications • Antihypertensives
• Benzodiazepines • Diuretics
• Anticonvulsants • Antihistamines
• Sedative hypnotics
• Antidepressants
• Antipsychotics
• Opiates
• Antiarrhythmics
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NPSF Professional Learning Series

Reassessment
• Suggested intervals for reassessment of
falls risk:
▫ Upon transfer from one unit to another
▫ With any status change
▫ Following a fall
▫ At regular intervals
▫ With change in caregiver

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NPSF Professional Learning Series

Postfall Risk Assessment
• Obtain history of falls from the patient and
witnesses
• Note the circumstances (e.g. time, location, activity)
• Review underlying illness and problems
• Review medications
• Assess functional, sensory and psychological
status
• Evaluate environmental conditions
• Review risk factors for falling
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NPSF Professional Learning Series

Postfall Risk Assessment, cont'd
• Results serve two purposes
▫ Modify the plan to prevent repeat falls
▫ Begin postfall investigation process, from which
lessons learned can be applied to all patients

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NPSF Professional Learning Series

Evidence-based Falls
Prevention Strategies

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NPSF Professional Learning Series

Key Components of Falls
Prevention
• Organizational support and leadership
• Multidisciplinary falls prevention team
• Risk assessment
• Multifactorial interventions
• Communication
• Reassessment
• Data collection & quality improvement

(VHA NCPS 2004)

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NPSF Professional Learning Series

Grading Levels of Evidence
• Level I: Systematic reviews (integrative/meta-
analyses/clinical practice guidelines based on systematic
reviews)
• Level II: Single experimental study (randomized controlled
trials [RCTs])
• Level III: Quasi-experimental studies
• Level IV: Non-experimental studies
• Level V: Care report/program evaluation/narrative literature
reviews
• Level VI: Opinions of respected authorities/ Consensus
panels
(Capezuti, et al., 2008)
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NPSF Professional Learning Series

Organizational Support and Leadership
Level of Evidence: V, VI

• Strong organizational support is necessary for

the success of any falls reduction program
• Policies and protocols alone will not significantly
impact rates of falls and falls with harm
• Organizations must allocate resources to
implementing a falls reduction program
▫ Without additional resources, the program may
increase falls rates
(Healey 2007, Lancaster 2007, Cameron 2010)

Guidelines: ICSI, NCPS, RNAO

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NPSF Professional Learning Series

Multidisciplinary Falls Prevention Team
Level of Evidence: IV

• Requires support across

departments and disciplines
• Consists of clinical and non-
clinical staff
• Engages the medical staff

Guidelines: ICSI, RNAO, NCPS

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NPSF Professional Learning Series

Multifactorial Interventions
Level of Evidence: I

• Effective falls prevention interventions

▫ Address common reversible falls risk factors in all
patients (Oliver 2004)
▫ Target multiple individual risk factors
▫ Are delivered by an interdisciplinary team (Cameron
2010)

Guidelines: ICSI, HCANJ, HIGN, NCPS, NICE, PSF, RNAO, TCAB

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NPSF Professional Learning Series

Standard Falls Prevention
Interventions
• Familiarize the patient to the
environment
• Place call bell within reach and
have patient demonstrate use
• Position necessary items within patient reach
• Keep hospital bed in low position with brakes locked
• Ensure patient wears non-slip, well-fitting footwear

Guidelines: ICSI, HIGN, NCPS, PSF, RNAO, TCAB

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NPSF Professional Learning Series

Standard Falls Prevention
Interventions

• Provide night light or supplemental lighting

• Keep floor surfaces clean and dry
• Clean up spills promptly
• Install handrails in patient bathrooms, room and
hallway
• Maintain clutter-free patient care areas

Guidelines: ICSI, HIGN, NCPS, PSF, RNAO, TCAB

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NPSF Professional Learning Series

Interventions for Patients at Risk for Fall
• Use visual alerts to communicate falls risk
▫ Sign outside door and in room
▫ Wrist band Fall
▫ Colored socks/blankets Risk
▫ Alert in electronic medical record
• Provide cued toileting at least every two hours
while awake
• Remain with the patient when assisted to the
bathroom or commode
Guidelines: ICSI, HIGN, NCPS, PSF, RNAO, TCAB
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NPSF Professional Learning Series

Interventions for Patients at Risk for Fall
• Use safe patient handling techniques and
assistive devices for all transfers
• Use low beds and floor mats when appropriate
• Use bed and chair alarms, if necessary
• Provide frequent or continuous observation, if
necessary

Guidelines: ICSI, HIGN, NCPS, PSF, RNAO, TCAB

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NPSF Professional Learning Series

Hourly Rounding
Level of Evidence: III, IV, V, VI
• The Four P’s
▫ Position
▫ Pain assessment
▫ Personal needs (“potty”)
▫ Placement
• Results
▫ Reduction in falls
▫ Increase in patient satisfaction
▫ Increase in staff satisfaction
▫ Decreased call bell use
▫ Decreased distance walked by nursing staff
(Halm 2009)
Guidelines: ICSI, NCPS, TCAB
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NPSF Professional Learning Series

Alarms
Level of Evidence: V, VI

• Alarms are mentioned in several

guidelines
• Be sure staff are trained in their proper
use according to manufacturer’s
instructions
• Ideally the alarm should be triggered in
time for staff to respond and prevent a
fall
Guidelines: HIGN, ICSI, NCPS, TCAB

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NPSF Professional Learning Series

Low Beds
Level of Evidence: V, VI
• Low beds have been included as part of
effective multifactorial falls prevention plans
(Lancaster et al., 2007)
• It is difficult to isolate the impact of low beds
• Research suggests no significant increase or
decrease in the rate of injuries or falls from bed
(Anderson et al., 2011)

Guidelines: HIGN, ICSI, NCPS, RNAO, TCAB

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NPSF Professional Learning Series

Continuous Observation (AKA “Sitters”)
Level of Evidence: V, VI

• Provide training to designated staff

• Create clear guidelines for use of
continuous observation
• Monitor outcomes (e.g. falls with
injury) and balancing measures (e.g.,
restraint use) to support cost
justification (Harding 2010)

Guidelines: ICSI, NCPS, TCAB

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Communication
• Visual communication
• Communication to patients and families
• Communication to the healthcare team

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Visual Communication
Level of Evidence: V, VI

• Signage
• Patient chart
• Bracelets
• Socks
• Blankets

All healthcare workers must be educated to recognize these visual

cues. Caution must be given to “sign fatigue”
Guidelines: HCANJ, HIGN, ICSI, NCPS, RNAO, TCAB

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NPSF Professional Learning Series

Communication to Patients and Families
Level of Evidence: V, VI

• Communicate risk factors identified

• Explain hospital falls prevention program
• Engage patient and family as members of the
falls prevention team and get their input into the
plan
• Provide education using the
“Teach Back” method

Guidelines: HCANJ, HIGN, ICSI, NCPS, RNAO, TCAB

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NPSF Professional Learning Series

Communication to the Healthcare Team
Level of Evidence: V, VI

• Housewide, interdisciplinary ongoing education

• Transport checklist (“Ticket to Ride”)
• Handoff Tool (SBAR)
• Patient Safety Huddle
• Post Fall Huddle

Guidelines: HCANJ, HIGN, ICSI, NCPS, RNAO, TCAB

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 Falls Measurement

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Falls Risk Assessment Findings
• Identified gaps in the Authority’s adverse event
reports
▫ Risk assessments
▫ Identification of patients at risk for falls
▫ Prevention strategies in place
• Development of falls dashboard and process
measure report

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NPSF Professional Learning Series

Pennsylvania Risk Assessment Compliance

2011 Patient Safety Reporting System Data

Falls Questions
Risk Assessment Identified at Risk Fall Prevention
for Fall Strategies in Place
Yes 64.4% 59.7% 65.2%
Responses

No 5.2% 18.1% 15.0%

Unknown 4.3% 6.6% 4.8%

No Response 26.1% 15.6% 15.0%

Total 100% 100% 100%

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NPSF Professional Learning Series

Falls Dashboard

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NPSF Professional Learning Series

 Risk Assessment Compliance
Falls Risk Assessment
Yes No Unknown No Response Total
Falls Risk Assessment Completed 16 0 4 9 29
Patient Identified at Risk of Fall 13 0 0 16 29
Falls Precaution(s) in Place 16 5 0 8 29
Prior History of Falls in the past 12 6 5 1 17 29
months

• Unknown and no response on adverse event

reports identified gaps
• Possibly a documentation issue

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Falls Details Report

• Identify patterns between falls event types and patient characteristics

• Inform falls prevention strategy choices

• Identify patterns between falls event types and

patient characteristics
• Inform falls prevention strategy choices

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NPSF Professional Learning Series

Falls Prevention Strategy Report

• Identify patterns in falls event types and implemented prevention strategies

• Standardized falls event type categories

• Identify patterns in falls event types and

implemented prevention strategies
• Standardized falls event type categories
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Process Measure Report

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Risk and Strategy Process
Measure

• Drill down reporting capabilities

▫ Identify specific patient events
▫ Learn details about circumstances
• Identify patterns and investigate
• Make changes based on new information

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Point Prevalence Audit Tool
Facility: Date:
Falls Prevention Process Measures Audit Tool
Unit: Census:
DOCUMENTATION VISUAL OBSERVATION

Was patient identified at risk

Is special equipment in use?

Is there documentation of
Was falls prevention plan

education documented?

Is call bell within reach?

Was patient and family

appropriate footwear?
Does patient have risk
Was risk assessment

Are alarms in use?

Does patient have

Is sitter in place?
Enter risk score

hourly rounds?
documented?
completed?

identifiers?
to fall?
Room Patient
# ID
□ sign
outside
room
□ sign □ non-skid □ low bed
inside socks/slipp □ 2 side □ bed
room ers rails up alarm
□ wrist □ rubber □ floor mat □ chair
Y N Y N Y N Y N Y N Y N Y N
band soled □ hip alarm
□ colored shoes protectors □ other
blanket □ other □ other ________
□ colored ________ ________
socks
□ other
________
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NPSF Professional Learning Series

Point Prevalence Audit Report
• Graphs have
been created to
display
individual
facility results,
and
comparison to
group averages

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NPSF Professional Learning Series

“Sometimes I wish for falling
Wish for the release
Wish for falling through the air
To give me some relief
Because falling's not the problem
When I'm falling I'm in peace
It's only when I hit the ground
It causes all the grief”

― Florence Welch
(lead singer, Florence and the Machine)

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Thank you for your attention.

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NPSF Professional Learning Series

 Falls Prevention Guidelines
• Hartford Institute for Geriatric Nursing (HIGN)
▫ Gray-Micelli D. Preventing falls in acute care. In: Capezuti E,
Zwicker D, Mezey M, Fulmer T, editor(s). Evidence-based
geriatric nursing protocols for best practice. 3rd ed. New York
(NY): Springer Publishing Company; 2008. p. 161-98. [cited
2012 May 15]. Available from Internet:
http://guideline.gov/content.aspx?id=12265

• Health Care Association of New Jersey (HCANJ)

▫ Health Care Association of New Jersey. Fall management
guidelines [online]. 2007 Mar [cited 2012 May 15]. Available
from Internet: http://www.hcanj.org/docs/hcanjbp_fallmgmt6.pdf

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 Falls Prevention Guidelines
• Institute for Clinical Systems Improvement (ICSI)
▫ Institute for Clinical Systems Improvement . Health care protocol:
prevention of falls (acute care) [online]. 2012 Apr [cited 2012 May
15]. Available from Internet:
http://www.icsi.org/falls__acute_care___prevention_of__protocol_
/falls__acute_care___prevention_of__protocol__24255.html

• National Center for Patient Safety (NCPS)

▫ National Center for Patient Safety. Falls toolkit [online]. 2004 Jul
[cited 2012 May 15]. Available from Internet:
http://www.patientsafety.gov/SafetyTopics/fallstoolkit/index.html

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Falls Prevention Guidelines
• National Institute for Clinical Excellence (NICE)
▫ National Institute for Clinical Excellence. Clinical practice
guideline for the assessment and prevention of falls in older
people [online]. 2004 Nov [cited 2012 May 15]. Avaialble from
Internet:
http://www.nice.org.uk/nicemedia/pdf/CG021fullguideline.pdf

• Patient Safety First (PSF)

▫ Patient Safety First. The ‘how-to guide’ for reducing harm from
falls [online]. 2009 Sep [cited 2012 May 15]. Available from
Internet:
http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/Inte
rvention-support/FALLSHowo%20Guide%20v4.pdf
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 Falls Prevention Guidelines
• Registered Nurses’ Association of Ontario
(RNAO)
▫ Registered Nurses’ Association of Ontario. Prevention of falls and
fall injuries in the older adult [online]. 2011 [cited 2012 May 15].
Available from Internet: http://rnao.ca/sites/rnao-
ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adu
lt.pdf

• Transforming Care at the Bedside (TCAB)

▫ Institute for Healthcare Improvement. Transforming Care at the
Bedside How-to guide: reducing patient injuries from falls [online].
2008 [cited 2012 May 15]. Available from Internet:
http://www.ihi.org/knowledge/Pages/Tools/TCABHowToGuideRed
ucingPatientInjuriesfromFalls.aspx
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Falls Prevention Guidelines

• Agency for Healthcare

Research and Quality (AHRQ)
▫ Agency for Healthcare Research and
Quality. Preventing Falls in Hospitals: A
Toolkit for Improving Quality of Care
[online]. 2013 Jan [cited 2013 Feb 25].
Available from Internet:
http://www.ahrq.gov/research/ltc/fallpxt
oolkit/index.html

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 Reference Articles
• Ang NKE, Mordiffi SZ, Wong HB, Det al. Evaluation of three fall-risk assessment
tools in an acute care setting. Journal of Advanced Nursing 2007;60(4),427–435
• Anderson O, Boshier P, Hanna G. Interventions designed to prevent healthcare
bed-related injuries in patients. Cochrane Database of Systematic Reviews
2011;11:1-30.
• Cameron ID, Murray GR, Gillespie LD, et al. Interventions for preventing falls in
older adults in nursing care facilities and hospitals. Cochrane Database of
Systematic Reviews 2010;1:1-117.
• Capezuti, E., Zwicker, D., Mezey, M. & Fulmer, T. (Eds). (2008) Evidence Based
Geriatric Nursing Protocols for Best Practice, (3rd ed). New York: Springer
Publishing Company.
• Child Health Corporation of America Nursing Falls Study Task Force. Pediatric
falls: state of the science. Pediatric Nursing 2009 Jul-Aug;35(4):227-231.
• Halm M. Hourly rounds: what does the evidence indicate? American Journal of
Critical Care 2009 Nov;18(6):581-584.

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 Reference Articles
• Harding AD. Observation assistants: sitter effectiveness and industry measures.
Nursing Economics 2010 Sep-Oct;28(5):330-336.
• Healey F, Scobie S. Slips trips and falls in hospitals. London (UK): National
Patient Safety Agency; 2007.
• Hendrich A. Predicting patient falls: Using the Hendrich II Fall Risk Model in
clinical practice. American Journal of Nursing 2007 Nov;107(11):50-58.
• Inouye SK, Brown CJ, Tinetti ME. Medicare nonpayment, hospital falls, and
unintended consequences. NEJM 2009 Jun;360(23):2390-2393.
• Lancaster AD, Ayers A, Belbot B, et al. Preventing falls and eliminating injury at
Ascension Health. Jt Comm J Qual Patient Saf 2007 Jul;33(7):367-375.
• Oliver D, Daly F, Martin FC, et al. Risk factors and risk assessment tools for falls
in hospital in-patients: a systematic review. Age Ageing 2004 Mar;33(2):122-30.
• Perell KL, Nelson A, Goldman RL, et al. Fall risk assessment measures: an
analytic review. J Gerontol A Biol Sci Med Sci 2001 Dec;56(12):M761-6.
• Quigley P, Hahm B, Collazo S, et al. Reducing serious injury from falls in two
veterans’ hospital medical-surgical units. J Nurs Care Qual 2009 Jan-
Mar;24(1):33–41
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Submit a Question

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of you to review and print your certificate AND an auto e-mail is sent to your e-mail address
with the same link.
*Continuing education credits are only available for live webcasts. A post-event survey must be
completed within 7 days of participation to receive continuing education credits.
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NPSF Professional Learning Series

 CME Certificate Instructions
• For CME, please visit the following link to
complete your evaluation:

https://www.surveymonkey.com/s/RGJRQH3

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NPSF Professional Learning Series