Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries from Falls

Institute for Healthcare Improvement (in collaboration with the Robert Wood Johnson Foundation)
Cambridge, Massachusetts, USA

How to cite this document:
Boushon B, Nielsen G, Quigley P, Rutherford P, Taylor J, Shannon D, Rita S. How-to Guide: Reducing Patient Injuries from Falls. Cambridge, MA: Institute for Healthcare Improvement; 2012. Available at

This How-to Guide can help staff learn to identify the patients on medical-surgical units who are at the highest risk for sustaining a serious injury from a fall and implement interventions to prevent or mitigate these injuries. Both physical injury (such as hip fracture) and emotional harm (such as subsequent fear of falling) can occur as a result of a fall. While acknowledging the emotional harm that may result from repeated falls or from falls with no apparent injury, this guide focuses on approaches to reduce physical injury associated with patient falls that occur on inpatient units.
This is How-to Guide is divided into four sections:
  • Section One highlights six promising changes designed to reduce serious injuries from falls for hospitalized patients. It also includes references and links to helpful resources.
  • Section Two outlines practical step-by-step activities for testing, adapting, and implementing the proposed changes described in Section One.
  • Section Three includes resources and tools from hospitals engaged in fall prevention work: Fall Risk Assessment Tool, Nursing Handoff Checklist, Safety Huddle Form, Tips for Using Teach Back, and more.


This How-to Guide was initially developed as part of the Transforming Care at the Bedside (TCAB) initiative, a national effort of the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement.

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