Article Text

other Versions

Download PDFPDF
Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study
  1. Kea Turner1,
  2. Vincent Staggs2,
  3. Catima Potter3,
  4. Emily Cramer4,
  5. Ronald Shorr5,6,
  6. Lorraine C Mion7
  1. 1Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
  2. 2Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA
  3. 3Press Ganey Associates Inc, South Bend, Indiana, USA
  4. 4School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
  5. 5GRECC (182), Malcom Randall VAMC, Gainesville, Florida, USA
  6. 6Department of Epidemiology, University of Florida, Gainesville, Florida, USA
  7. 7Ohio State University College of Nursing, Columbus, Ohio, USA
  1. Correspondence to Professor Kea Turner, Moffitt Cancer Center, Tampa, FL 32026, USA; kea.turner{at}


Background To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.

Objective To identify and describe the prevalence of specific hospital fall prevention implementation strategies.

Methods In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.

Results A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).

Conclusions Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.

  • Fall prevention
  • implementation strategies
  • hospital falls

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @rshorr

  • Contributors KT drafted the manuscript and conducted the analyses. VS, CP and EC provided guidance on the data analyses and reviewed drafts of the manuscript. LCM and RS oversaw the data collection and analyses process, reviewed the manuscript and provided overall guidance on the study.

  • Funding This study was funded by National Institute on Aging (grant number:R56 1R56AG051799-01).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The University of Kansas Medical Center Institutional Review Board (IRB) approved this study. Individual hospital sites either accepted the University of Kansas Medical Center IRB or applied their own IRB approval prior to data collection.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party. The data used in this study were obtained from National Database of Nursing Quality Indicators (NDNQI) and cannot be made publicly available. NDNQI data are proprietary and must be obtained from NDNQI directly.