Top Drivers of Medical Practice Risk: Failure to Ensure Fall Safety

In this blog series, Lori Duffy discusses the top drivers of risk and malpractice claims and explores strategies to mitigate risk and enhance patient safety.

In the Top Drivers of Risk series, I discuss the most common malpractice allegations across all healthcare settings and explore strategies to enhance patient safety and minimize risk.

This month, I'll examine the allegation of failure to ensure safety from falls. At Curi, we analyze our malpractice claims to identify and examine the top allegations, helping clinicians and their organizations implement strategies to reduce adverse events and claims.

Failure to Ensure Safety from Falls

In the subset of Curi claims analyzed, failure to ensure safety from falls is the fourth most frequent allegation and the sixth most expensive across all healthcare settings. Most of these claims (71%) involved nursing team members (e.g., RNs, LPNs, and assistants), and just over half of fall allegations (52%) occurred in the hospital patient room (32%) or senior living center (20%). Less than 10% occurred in a medical office setting.

Many of the top contributing factors in these claims center around errors in clinical judgment, failure to follow organizational policies, staffing issues, and breakdowns in communication among the team. Errors in clinical judgment comprise failure to implement fall safety measures and patient assessment/monitoring issues. A common theme in these fall events was a team member leaving a high-risk patient (e.g., an older adult, a young child, or a sedated person) unattended. Understanding the top contributing factors in these claims provides data-driven insights into where to prioritize your organization’s fall prevention efforts.

Falls are a common cause of injuries and malpractice claims. Age-related factors, medication effects, sedation, or mobility issues put patients and residents at a higher risk of falling, which can lead to serious complications such as fractures and head injuries. Implementing a comprehensive fall reduction program in all healthcare settings is essential to mitigate these risks.

Fall Reduction Program

Components of a comprehensive fall reduction program often include:

Fall Risk Assessments

• Perform routine fall risk assessments for patients and residents upon admission, upon a change of condition, and periodically thereafter. Screen older patients for fall risk in the medical office setting.
• Employ standardized and validated fall risk assessment tools and train team members to use them accurately.
• Analyze the effectiveness of your risk assessment’s ability to predict falls.

 Person-Centered Targeted Interventions

• Create individualized plans based on the identified risk factors.
• Use color-coded risk identification systems to help team members quickly recognize at-risk individuals.
• Implement frequent check-ins for high-risk individuals, ensuring timely assistance and supervision.
• Collaborate with pharmacists to review and identify medications that may cause dizziness, drowsiness, or low blood pressure.

 A Safe Environment

• Keep hallways, patient/resident rooms, and bathrooms well-lit and clutter-free.
• Install handrails and grab bars in hallways, bathrooms, and common areas.
• Adjust bed heights to reduce the chance of a fall when getting in and out of bed.
• Monitor young children and sedated individuals on treatment tables, and don’t leave them unattended.

 Team Training and Awareness

• Provide education for team members on critical thinking skills, fall prevention strategies, team communication, and emergency response procedures using scenario-based learning modules.
• Educate the team on medication side effects that may increase fall risk, such as dizziness and drowsiness.
• Encourage a team-based approach to fall prevention involving physicians, nurses, physical therapists, and pharmacists.

 Family, Patient, and Resident Involvement

• Engage family members in fall prevention education and strategies.
• Encourage open communication between caregivers, patients, and residents about concerns related to mobility and balance vs. fall risk reduction.
• Discuss realistic expectations on fall reduction with families using a shared decision-making and person-centered model.

 Fall Investigation and Performance Improvement

• Conduct post-fall huddles immediately to begin the fall investigation process.
• Use an incident report form specifically designed to collect data on evidence about the factors contributing to fall occurrences.
• Perform a root cause analysis of the fall event to revise the care plan and improve team performance.

Curi Resources

Curi clients, sign in to our Risk Solutions Resource Catalog to take one of our Risk Assessments, watch the on-demand video Claims Insights: Mitigating Fall Adverse Events, and access our Toolkits:

• Mitigating Fall Risks in Senior Living Toolkit
• Preventing Falls in the Medical Office Setting Toolkit
• Reducing Hospital Patient Adverse Events Toolkit

If you have questions about this topic, please call 800-328-5532 to speak with one of Curi Advisory's Risk Solutions Consultants.

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