Developing a Risk for Falls Care Plan: Facility Guide

Falls are the primary cause of injury in hospitalized older adults and can lead to increased lengths of stay, lifelong pain, and patient death. Patient falls make up 47% of all healthcare safety events — what’s worse, 30% of those falls could have been prevented with the implementation of an evidence-based risk for falls care plan.’

Healthcare providers can improve patient outcomes and optimize fall-prevention practices by screening high-risk patients and developing care interventions to address fall risk. In this article, we review the importance of fall prevention for patients and facilities and provide a risk for falls nursing care plan template to help care providers improve patient safety and care quality in their organization.’

How Do Falls Impact Patients and Facilities?

Patient falls create significant physical and economic challenges to both patients and care facilities. The statistics can be startling:

• 1 in 4 adults over the age of 65 report falling every year.
• 1 million patients fall in hospitals each year, making up nearly half of all healthcare safety events.
• Over 20% of falls cause bone fracture, soft tissue injury, or head trauma.
• Nearly 11,000 hospitalized patients die annually after falling inside of their care facility.
• Each fall costs healthcare facilities an average of $62,500 and puts organizations at risk of hefty fines and reduced CMS reimbursement.

Healthcare providers can reduce the prevalence of patient falls by developing a risk for falls care plan, educating patients and family members on fall reduction strategies, and establishing multidisciplinary strategies to reduce injury and optimize patient safety.’

Risk for Falls Nursing Care Plan Template

Fall prevention care plans should follow the “ADPIE” structure of the nursing process:

• Assess: Assess for factors that contribute to a risk for falls.
• Diagnose: Diagnose high-fall risk individuals.’
• Plan: Plan patient goals and intended care outcomes.
• Implement: Implement interventions to reduce fall risk.
• Evaluate: Evaluate intervention effectiveness.’

Assess for Factors that Contribute to a Risk for Falls

Your care plan should begin by screening patients for the following fall risk factors:

• Aged 65 and over
• Cognitive impairment, delirium, or psychosis
• Vitamin or nutrient deficiency
• Vision or hearing difficulties
• Use of medications that affect judgment, balance, and coordination

Tip: Many electronic health record (EHR) charting systems allow providers to chart a patient’s fall risk as part of the comprehensive nursing assessment. Utilize an evidence-based fall risk assessment tool like the Morse Fall Scale or the Johns Hopkins Fall Risk Assessment to screen for high-risk patients.

Standardized facility-wide screening practices ensure that all risk factors are considered for each patient. Once risk is identified, it’s important to formally diagnose the patient so that all clinical team members are aware of the potential for injury and can tailor care strategies to limit risk.

Formulate a Nursing Diagnosis for Falls

In elderly patients and other high-risk groups, it’s important that providers diagnose patients with a risk for falls to develop unique treatment strategies that meet patient needs. A nursing diagnosis is usually written in the following format:

Risk for [patient problem] as evidenced by [risk factors]

Here are a few fall-related nursing diagnoses to help get you started:

• Risk for falls as evidenced by impaired gait.
• Risk for falls as evidenced by the use of assistive walking devices.
• Risk for falls as evidenced by orthostatic hypotension.

Create Risk for Falls Goals and Expected Outcomes

This section of the risk for falls care plan outlines what the nurse hopes to achieve by implementing patient-specific nursing interventions. Forming well-written clinical goals helps care teams plan interventions and evaluate the success of implemented fall-prevention strategies. Example fall-reduction goals include the following:

• The patient will remain free of falls throughout their hospitalization.
• The patient will verbalize understanding of fall-related education and will describe three ways they can reduce their fall risk after discharge.
• The patient will demonstrate appropriate posture and form while using the assistive walker.

These goals are revisited after the completion of the care interventions to ensure the anticipated outcomes have been met.

Tip: Create goals that are SMART (specific, measurable, achievable, relevant, and time-sensitive). This will help you clearly determine whether clinical objectives and goals have been met.

Develop and Implement Risk for Falls Nursing Interventions

It’s important to plan and implement research-driven nursing interventions to prevent falls in older adults and other vulnerable patient populations. While every intervention might not be implemented each day, it’s helpful to have a list of care strategies providers can use to structure their clinical shifts.

Examplerisk for falls interventions include the following:

• Provide the high fall risk patient with yellow wristbands and non-slip socks and place yellow warning signs above the patient’s door to remind healthcare providers that the patient needs strict monitoring during toileting and physical activity.
• Keep the patient’s room free of clutter and remove IV lines and device cords from the floor to prevent tripping. Keep the bed in a low and locked position at all times.
• Review fall-risk prevention strategies with the patient and their family members. Provide pamphlets and written guidance to reference after returning home.
• Encourage assistance when using the toilet or getting out of bed. Place the nurse call bell and other personal items (cell phone, glasses, glass of water) in a visible location that is easy for the patient to reach.
• Coordinate physical and occupational therapy services to help the patient regain strength to complete daily living activities.

Perform a Care Plan Evaluation

For risk for falls care plans, it’s important to review care outcomes during and after intervention implementation. Keep track of patient safety events like falls and “near misses” to ensure that care strategies are effective. Goals and interventions can be adjusted at any time to address any changes in the patient’s condition.

Update Your Nursing Care Plans and Optimize Health Outcomes

Falls harm not just patients, but care facilities too. Ensuring your team has a well-written risk for falls care plan is a key step toward improving patient safety. Get the IntelyCare newsletter for more facility guides and evidence-based care improvement tips.