Namina Rupp

Fall Prevention: An Agreement Between Patient and Nurse

PICO Question:

Does implementing a Fall Prevention Agreement between staff and patient impact the patient’s understanding of fall risks, staff’s understanding of contributing factors for fall risk and ultimately impact the incidence of falls on the transitional and acute care unit (10 CVT)?


Falls are multi-factorial and complex and fall and fall-related injury rates are important patient outcomes in the National Database of Nursing Quality Indicators (NDNQI). The aim of this project is to implement a Fall Prevention Agreement between staff and patients to increase the patients’ understanding of fall risks and staff’s knowledge of contributing factors and decrease falls on 10CVT.


Falls can be detrimental to a patient’s recovery and costly. Even with standard fall precautions in place, patients are falling. On the unit studied (10CVT) alone, there were 32 falls, including 8 falls with injury, in FY2020. The unit’s FY2020 IAP goal was to decrease the total number of patient harm events. Review of the literature shows that combining a fall prevention agreement with standard fall precaution measures can increase patient education and adherence to fall prevention.

Strategy/Implementation/ Methods:

A Fall Prevention Agreement was created, and staff were educated via posters and during staff meetings and Unit Based Council meetings about contributing factors to falls along with a standard fall assessment. Patients who were identified as high falls risk or who had contributing factors were targeted. Patients were educated about their risk and the agreement was signed between patient and staff during admission, transfers and change of status. The signed agreement was placed next to the white board visible to patient at all times. Patients who were alert, oriented and English-speaking were included. The project was implemented for three months, and surveys were collected every two weeks.


The patients who used the Fall Agreement had higher understanding of their fall risk. At the baseline, 62.9% of patients strongly agreed that they were at risk for fall. The percentage increased to 84.36%, 94.1% and 75% on post- 1, 2 and 3 respectively. The 10 CVT staff were knowledgeable about the contributing factors with the vast majority agreeing that identified factors contributed to the fall risk in all collection periods. However, more adoption was needed from the staff as only 52.5%, 46.3% and 61.2% of staff stated that they used the agreement during post- 1, 2 and 3 respectively. Fall rate decreased from 2.26 to 1.30 over three months during the implementation of the agreement.

Conclusions/Implications for Practice:

Results are promising, showing use of the Fall Prevention Agreement reduced the fall rate on 10CVT, increased patients’ understanding of their fall risks, and kept staff’s knowledge in mind, but long-term study and more adoption is needed from staff to determine the effectiveness of the agreement.