Preventing Falls and Fall-related Injuries in Health Care Facilities


Falls with serious injury are consistently listed as one of the Top 10 Sentinel events reported to the Joint Commission Sentinel Event database. While extensive clinical research and evidence-based strategies in fall prevention exist, reducing injurious falls in the hospital environment remains difficult. Falls are a serious patient safety problem, accounting for nearly 84% of all inpatient incidents. Among adults 65 years or older, falls are the leading cause of injury-related death. A fall resulting in a serious injury can cost an additional $13,300 and increase the length of stay by 6.27 days for each patient.

Literature review shows that close to one-third of falls can be prevented. A comprehensive fall prevention program includes managing a patient’s underlying fall risk factors and optimizing the hospital’s physical design and environment.

 Several factors contribute to falls such as variation in assessment tools to identify fall risk factors, ineffective communication and handoffs, inadequately individualizing a patient’s plan of care and physical environment.

The Washington State Hospital Association (WSHA) is committed to support, guide and assist hospital staff in implementing a fall with injury prevention program. 

 A high-reliable and sustainable fall prevention program includes: organizational leadership support, an interdisciplinary and diverse team that meets routinely and systematically to analyze fall data and identify trends and opportunities for continuous improvement; a standard comprehensive fall risk assessment tool, communication plan and educational training for all staff, patient and family engagement and a standard post fall management process.

Measure Definition

NQF 0202 Measure Definition

Getting Started

Fall with Injury Prevention Top 10 Best Practices

Organization and Unit Level Gap Analysis Tool

Safety Action Bundle Strategic Planning Tool  

Safety Action Bundle

Hendrich II Fall Risk

Johns Hopkins Evidence-Based Fall Safety Initiative

Johns Hopkins Fall Risk Assessment Tool for Acute Care

Johns Hopkins Fall Risk Assessment Tool for Home Health Care

Morse Fall Assessment User Guide


Post Fall Huddle Tool 

Post Fall Audit Tool


Hester Davis 


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