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  • Falls: Patient safety from the healthcare system culture to the community culture

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    Patients falling (falling, slipping) is considered one of the most important patient safety risks in the elderly, in health institutions (hospitals, health centres..., etc.) in particular, and more generally in daily life activities at home, out shopping, etc. In this article I call for a cultural transformation for avoiding falls: from a culture of patient safety that focuses on falls within health facilities to a wider societal culture that must be adhered to by all members of society to prevent the risks of falling in the elderly and other groups at high-risk (including those with specific diseases, disabilities due to congenital causes, accidents...).


    In this article, I explore what we mean by patients falling, what the consequences are and what we should do to prevent the risks of falling.

    What is patient falling?

    Simply, the patient falling is defined as the patient falling to the ground, whether from a bed or chair or while walking, which can be caused by many factors. 

    What are the causes of falls?

    Falls can happen for a  number of reasons, many of the causes are common and there are many factors that can frequently increase the risk of falling in health facilities or outside them:

    1. Reasons related to the person or the patient, such as some health conditions, dizziness, poor vision, general weakness, being older and many other pathological injuries, are considered to increase the risk of the patient falling.
    2. Reasons related to the environment surrounding the patient or the person at risk of falling; these reasons are many, including those related to the surface of the floor on which the patient walks, surfaces that cause sliding, the absence of lighting or low lighting, the presence of moveable obstacles, whether furniture or other, the absence of installed supports such as handles on doors, etc.
    3. General reasons related to natural factors, climate and disasters.

    Fall risk

    Fall injuries are considered one of the highest patient safety risks and the most costly in health facilities or in the community where the effects of falls can be monitored according to the severity of the fall. Some simple falls may not produce injuries, but they pose a risk to the patient.

    Falling is one of the threats to the safety of patients inside health facilities but also poses a safety threat in the community for people at risk of falling. Falls can increase the burden of an already longstanding disease and/or cause an additional sickness burden to the patient as a result of serious injuries caused by the fall, such as head injuries, bone fractures and wounds. The severity of the injury varies and is affected by other factors, such as age and the nature of the fall itself. It can cause an increase in hospitalisation and the length of stay in hospitals and may extend the risk of permanent disability, which in turn is a high economic cost on individuals and families and public spending budgets.

    Fall prevention

    Prevention of patient falls has become a priority in health facilities as a requirement of healthcare quality and patient safety. Most healthcare systems have developed policies and implemented procedures and evaluation tools to reduce and prevent patient falls, designing and adapting their systems accordingly. One such tool is the Morse tool, which is a performance tool used to assess a patient's risk of falling (weak, medium or high) and thus taking measures or interventions according to the patient’s condition to prevent falls.

    There are many safety interventions to prevent the risk of falling, including:

    • positioning of the floors so that they are designed to prevent slipping
    • placing anti-slip tools in bathrooms and rooms, as well as non-slip carpets if they do not hinder movement
    • using sticks
    • placing alarm devices and emergency bells for patients to call for help
    • paying attention to lighting
    • reviewing the health status of a person at high risk of falling and monitoring them periodically, especially those with eyes and visual acuity disorders
    • review the condition of lenses or glasses
    • close monitoring of patients with chronic diseases and other pathological conditions such as permanent disability, whether congenital or acquired.


    Although the prevention of patient falls is an international patient safety goal in health facilities, in this article I wanted to highlight a general call for community attention to the problem of falls as it is one of the general safety risks that endanger the safety of millions of people in homes, roads, workplaces, markets and transportation. As well as a public responsibility to take care of it in order to avoid its short and long-term effects and complications, and its high health, social and economic costs, it is also an early warning bell for health authorities to take care of patient safety issues related to patient falls.

    About the Author

    Dr Ahmed Khalafalla is a doctor in family medicine at the Ministry of Health in Saudi Arabia. He has an interest in healthcare quality, patient safety and healthcare system transformation.


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