Falls are one of the most common causes of harm to hospitalised patients, particularly in older adults. They can lead to significant morbidity, including fractures, head injury, prolonged admission, and loss of independence. Preventing falls is therefore a key patient safety priority.
Effective falls prevention requires a multidisciplinary team (MDT) approach, involving doctors, nurses, physiotherapists, occupational therapists, and pharmacists. When teams work together, falls can be reduced by up to 20–30%. This article provides a practical overview of how falls can be prevented on the ward, and is the first article in our series on how an MDT approach is used to prevent harm and ensure best patient care.
Contents
Risk Factors for Falls
Falls are often multifactorial. Common risk factors include:
- Previous history of falls
- Reduced mobility or muscle weakness
- Acute illness or delirium
- Cognitive impairment (e.g. dementia)
- Visual impairment
- Medications causing dizziness or hypotension
- Postural (orthostatic) hypotension
- Environmental hazards (e.g. clutter, poor footwear)
All patients should undergo a multifactorial falls risk assessment on admission, with risks reviewed throughout their hospital stay.
MDT Approach to Falls Prevention
Nursing Team
Nurses play a central role in day-to-day falls prevention.
- Ensure call bells and personal items are within reach
- Encourage patients to ask for help with mobilisation (“call, don’t fall”)
- Maintain a safe environment (clear clutter, adequate lighting)
- Monitor for delirium, dizziness, or changes in condition
- Implement care plans such as enhanced observation where needed
Physiotherapy and Occupational Therapy
Physiotherapists and occupational therapists focus on mobility and functional safety.
- Assess mobility, strength, and balance
- Provide appropriate walking aids
- Advise on safe transfers and mobilisation
- Recommend environmental adaptations
- Support early mobilisation to prevent deconditioning
Medical Team
Doctors are responsible for identifying and managing medical contributors.
- Review for causes of falls (e.g. infection, delirium, hypotension)
- Check lying and standing blood pressure
- Assess cognition and screen for delirium
- Optimise hydration and nutrition
- Ensure appropriate escalation and documentation
Pharmacy Team
Pharmacists help reduce medication-related risk.
- Review medications early in admission
- Identify drugs that increase falls risk (e.g. sedatives, antihypertensives)
- Rationalise or adjust medications where appropriate
Practical Measures on the Ward
Simple interventions can significantly reduce falls risk:
- Ensure appropriate footwear (well-fitting, non-slip)
- Keep walking aids within reach and in good condition
- Encourage patients to sit before standing and rise slowly
- Promote hydration and nutrition
- Keep the bed space clear of obstacles
- Ensure glasses and hearing aids are used if needed
Patients who feel dizzy should be advised to stop, sit down, and call for help.
Role of Patients and Families
Patients and families are important partners in falls prevention.
- Report any history of falls or dizziness
- Highlight concerns about confusion or mobility
- Help ensure the bedside area is safe before leaving
- Encourage use of call bells and walking aids
Key Principles
- Falls are usually multifactorial and preventable
- Prevention requires a coordinated MDT approach
- Small, consistent interventions make a significant difference
- Patient and family involvement is essential
Further Reading
Royal College of Physicians: Falls prevention in hospital: a guide for patients, their families and carers. https://www.rcp.ac.uk/improving-care/national-clinical-audits/falls-and-fragility-fracture-audit-programme-fffap/falls-prevention-in-hospital-a-guide-for-patients-their-families-and-carers/
Written by Dr S Dhaliwal (SHO)
Reviewed by Dr A Sidhu (CT2)
