False Assumptions in Falls

As the leader responsible for the development of a site framework on patient fall prevention I frequently come up with the argument that unless our site is using one of the fall risk assessment tools (FRATs) such as the Morse or Stratify, etc. we have not implemented an acceptable program. Those doing the arguing argue on the basis that if you use a specific tool you will reduce patient falls. In other words, using a FRAT causes patient falls to be reduced.

I'm critical of FRATs... all of the tools I have reviewed suggest significant issue with lack of specificity and sensitivity. More compelling is that knowing if a patient has a history of falling (an obvious risk factor) and asking the simple question of the bed side nursing or admitting physician as to whether they are concerned that the patient may fall are often just as useful as any tool.

My argument is that successful patient falls prevention is not about the tools used but about the culture of patient safety that has been created. In an earlier pilot of aspects of the fall prevention strategy the site know that it had been successful when a relatively new hire stated to a relative stranger that "we take preventing falls very seriously on this ward". Unless an organization approaches patient falls prevention (or any other initiative for patient safety) with transformation of culture in mind, effort will generally be wasted.