Fall Prevention Guidelines by Ontario Nurses


Fall prevention in elderly patients is among the key concerns of nurses working in clinical settings. According to Bouldin et al. (2013), the rate of falls among elderly patients in the United States is 3.56 falls per 1000 patients. Injuries from falls result in additional medical costs and extended length of stay, which affect the institution and health care in general. The chosen guideline provides recommendations for fall prevention and reducing injuries from falls in hospitals. The present paper will examine the guideline and compare it to existing fall prevention guidelines.

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Description and Authors

The guideline was created by the Registered Nurses Association of Ontario (RNAO, 2017) and focuses on fall and injury prevention in hospital patients. There are several types of recommendations presented in the guideline: practice, education, organization, and policy. For example, the RNAO (2017) recommends screening patients for the risk of falls and engaging those at risk in care planning and patient education about falls.

The guideline also recommends ensuring collaboration between leaders and interdisciplinary teams in implementing these provisions in healthcare organizations. The guideline was compiled by registered nurses, which is essential as it provides additional insight into the topic. As opposed to some specialized medical professionals, such as lab technicians or oncologists, nurses work in interdisciplinary teams at all times. Therefore, they understand the importance of involving all the participants in the implementation process. Additionally, nurses spend more time with patients than any other members of staff and thus have more knowledge about risk factors for falls and fall prevention interventions.


The authors used high-quality evidence when completing the guidelines. For instance, most of the recommendations use the Ia level of evidence, which indicates evidence obtained from meta-analyses or systematic reviews of randomized controlled trials or multiple qualitative studies (RNAO, 2017). These types of sources provide a high quality of evidence due to their increased validity and reliability. Some recommendations, such as 3.1 and 4.1, use evidence of levels III or IV, which are syntheses of qualitative research studies and well-designed non-experimental observational studies (RNAO, 2017).

However, this does not affect the overall quality of recommendations, as the vast majority of recommendations are based on strong or moderate evidence. In addition, the recommendations provided in the guidelines are supported by other research studies. For example, Jennings et al. (2016) found that targeting at-risk patients can increase the success of fall prevention interventions. Therefore, the recommendations provided by RNAO (2017) are well-founded.

Comparison with Existing Guidelines

Many existing guidelines use similar fall prevention methods. For instance, the Joint Commission (2015) also recommends using risk appraisal, developing individualized plans of care based on the risk of falls, include interdisciplinary teams in fall prevention, and apply evidence-based post-fall management. The Jackson Memorial Hospital, which is my current practice setting, uses the guidelines that are based mainly on the Joint Commission’s (2015) recommendations.

For instance, we conduct a patient survey at admittance to identify if the patient has any risk factors for falls, such as previous incidents of falls. The hospital’s guidelines also advise educating patients about their risk of falls and the organization’s fall prevention effort. However, the hospital’s guidelines do not focus on involving interdisciplinary teams in fall prevention, as nurses are the primary users of fall prevention methods.

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Overall, the RNAO (2017) guideline takes into account nurses’ perspectives on fall prevention and thus provides a comprehensive look at the problem. The guidelines are based on high-quality evidence from prior research studies and cover the main areas of fall prevention interventions. The guidelines can be successfully implemented in my institution to reduce the incidence of patient falls and to promote patient safety in general.


Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M.,… Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13-17.

Jennings, L. A., Reuben, D. B., Kim, S. B., Keeler, E., Roth, C. P., Zingmond, D. S.,… Ganz, D. A. (2015). Targeting a high-risk group for fall prevention: Strategies for health plans. The American Journal of Managed Care, 21(9), e519-e526.

Registered Nurses’ Association of Ontario (RNAO). (2017). Preventing falls and reducing injury from falls (4th ed.). Toronto, ON: RNAO.

The Joint Commission. (2015). Sentinel Event Alert 55: Preventing falls and fall-related injuries in health care facilities. Web.

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