The effect of a nursing intervention on the incidence of older patient falls

This paper describes the evaluation of a fall prevention protocol that combined the assessment of the mobility and confusion status of 2,023 patients aged 70 years and over and a toileting regimen for at risk patients who were both confused and having mobility problems. The six months' study was conducted in a 450 bed metropolitan teaching hospital and involved approximately 500 nursing staff in the hospital's medical and surgical wards. Almost five percent (4.7%) of patients in the study group fell; 13 patients fell more than once and the total number of falls was 112. Twenty-four percent of patients (n = 482) were assessed as being at risk of falling and 54% of falls (n = 61) occurred in the at risk group. Sixteen percent of these falls occurred in the sub-group who had been toileted according to the study protocol and 84% in the sub-group who had not been toileted according to the protocol. There were 53% fewer patient falls during shifts which complied with both the assessment and toileting protocol than during non-compliant shifts. Given the simplicity and effectiveness of the study protocol, the finding that it was not followed on 43% of shifts is of concern.