Prevention of falls among older patients in the hospital environment

Falls among older inpatients are a significant cause for concern, yet currently there is no national guidance on falls prevention programmes, and little evidence from the research literature on the effectiveness of hospital prevention programmes. This article explores the unique problems associated with falls in hospital, particularly the issues related to observation and supervision of patients with cognitive impairment. The evidence base for falls risk assessment and prevention strategies is examined. An interprofessional, multidimensional approach to falls and injury prevention is suggested as the most likely approach to be effective in hospital, and the contribution of specific strategies such as exercise and hip protection are examined. Ethical issues are considered and the role of restraint in falls management is rejected. The Kings College Hospital inpatient falls prevention programme is described as a practice example of an interprofessional, multidimensional approach. Finally, the nurse's role in implementing falls prevention strategies and leading future practice development is identified.