Fall TIPS: A Patient-Centered Fall Prevention Toolkit

This toolkit, developed through an AHRQ Patient Safety Learning Lab, consists of a formal risk assessment and tailored plan of care for each patient. The toolkit has reduced falls by 25 percent in acute care hospitals and is used in more than 100 hospitals in the United States and internationally.

Background

Falls are the most common cause of preventable injury. Being hospitalized puts patients at further risk for falls due to illness and the newness of the hospital environment. Unfamiliar surroundings, medications and treatments given in the hospital setting, and decreased activity can cause patients to become mentally confused, weak, and unsteady. Even patients who were active and independent at home may require assistance to complete simple activities safely while they are in the hospital, such as getting out of bed or using the bathroom.

The primary aim of this AHRQ-funded research (grant number P30HS023535) was to help patients and family members work with nurses and other healthcare providers to reduce falls in hospitals. The intervention is based on the theoretical underpinning that fall prevention in hospitals is a three-step process: (1) assessing fall risk, (2) developing a personalized prevention plan, and (3) executing the plan consistently.

Fall Prevention Toolkit

The research team led by Drs. Patricia Dykes and David Westfall Bates enhanced the Fall Tailoring Interventions for Patient Safety (TIPS) Toolkit to optimize patient and family engagement in the three-step fall prevention process. Fall TIPS is a nurse-led, evidence-based fall prevention intervention that uses bedside tools to communicate patient-specific risk factors for falls and uses a tailored prevention plan. The toolkit provides care team members with the information they need to routinely engage in the fall-prevention process. More information on toolkit development and testing is available in “Fall Prevention in Acute Care Hospitals: A Randomized Trial,” by Patricia Dykes, et al.

By leveraging health information technology, this enhanced intervention engages patients and families in the three-step fall prevention process. Investigators developed different Fall TIPS modalities (high and low tech) and let staff on each patient care unit choose the modality that best fit their workflow. Three modalities were tested across the different hospitals:

1. An electronic health record (EHR)-generated poster.
2. A laminated poster.
3. An e-bedside display that automatically reused data in the EHR to dynamically display the poster at the bedside.

All modalities provided access to real-time safety plans at the bedside, including patient-specific fall risk factors, tailored fall prevention interventions, and educational content to all members of the care team, including patients and families.

Target Audience

Nursing leaders at all levels, frontline nursing staff, certified professionals in healthcare quality, ancillary and staff, such as physical therapists, occupational therapists, and transporters.

Developers

Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

• Patricia C. Dykes, Ph.D., R.N.
• David Westfall Bates, M.D., M.Sc.

Brigham and Women’s Hospital, Boston, Massachusetts

• Zoe Burns, M.P.H.
• Taylor Christiansen, B.A.
• Megan Duckworth, B.A.
• Ann Hurley, D.N.Sc., R.N.
• Srijesa Khasnabish, B.A.
• Emily Leung, B.S.
• Shimon Shaykevich, M.S.

Other

• Jason Adelman, M.D., Columbia University, New York, New York, and Columbia University Irving Medical Center/New York–Presbyterian, New York, New York.
• James Benneyan, Ph.D., Northeastern University Healthcare Systems Engineering Institute, Boston, Massachusetts.
• Eileen Carter, Ph.D., RN Columbia University, New York, New York, and Columbia University Irving Medical Center/New York–Presbyterian, New York, New York.
• Frank Chang, M.S.E., Partners HealthCare, Boston, Massachusetts.
• Awatef Ergai, Ph.D., Northeastern University Healthcare Systems Engineering Institute, Boston, Massachusetts.
• Zachary Katsulis, M.S., Northeastern University Healthcare Systems Engineering Institute, Boston, Massachusetts.
• Stuart R. Lipsitz, Sc.D., Brigham and Women’s Hospital and Harvard University, Boston, Massachusetts.
• Maureen Scanlan, M.S.N., RN, Montefiore Medical Center, Bronx, New York.

Testing and Results

The researchers implemented the toolkit and conducted a nonrandomized controlled trial using stepped-wedge design between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. The analysis included 37,231 adult inpatients hospitalized in participating units. The results showed that the fall prevention toolkit was associated with a statistically significant 15 percent reduction in overall inpatient falls and a 34 percent reduction in injurious falls (Dykes, et al., 2020).

The team is currently completing efficacy and cost-benefit analysis of the Fall TIPS Toolkit in 12 hospitals across three healthcare systems funded through the AHRQ R18 mechanism (Generalizability and Spread of an Evidenced-based Fall Prevention Toolkit: Fall TIPS (Tailoring Interventions for Patient Safety), under grant number 1R18HS025128-01.