Date of Award

Spring 5-19-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor



Fall Prevention Assessment in the Intermediate Care Patient Population

Falls cause greater than 600,000 deaths per year and are the most common injury in people over 65 years of age. Fall prevention in the acute care setting has been identified as key goal in the most recent JCAHO review process. Falls on an intermediary care unit lead to an increased rate of morbidity, delayed discharge, and excess cost expenditure.

Even with appropriate evidence-based tools in place, Hospital A’s intermediate care unit, recorded an increased rate of falls; the highest rate in its health care system. An investigation identified factors contributing to the excessive fall rate. After assessing the current protocol, performing direct observation, reviewing charts, and surveying the nursing staff, appropriate protocols had been implemented and the patients’ risk of falling was documented accurately the electronic health record (EHR). However, in an excess of caution, signage had been posted identifying virtually all patients as high risk. The presumptive, unintended consequence of this practice was decreased attention the most at-risk patients and thus contributed to the increased fall rate.

An educational intervention for staff was developed and proposed to redirect attention to the protocol ensuring that posted signage and other aspects of the protocol accurately reflected each patient’s fall risk. Appropriate use of the protocol could allow nurses to be properly sensitized to high-risk patients and distribute resources more effectively. After a review of the relevant literature, a recommendation was made to add a validated tool to assess delirium as well. It is expected that including this assessment will further refine the identification of patients at high risk for falls.

Reinforcement of the existing, evidence-based, fall prevention protocol should heighten awareness as to appropriate signage of patient risk. Additional assessment of delirium will increase the sensitivity of identifying patients at higher risk of falling due to their compromised mental status. Successful implementation with this combined approach should decrease the rate of falls on an intermediate care unit thereby decreasing patient morbidity and excess hospital costs.