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

Last updated: December 2012

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.

Please note: Clinical content evolves rapidly as the scientific evidence-base changes. The content of this report was last updated December 2012.

Therefore, this report may not reflect scientific changes that have taken place since that time and may not be aligned with the most recent clinical evidence and practice guidelines. The information provided in this report is for informational purposes only, and is not diagnostic or formal clinical guidance. IHI expressly disclaims any and all representations and warranties with respect to the content of the report, including without limitation any representation or warranty with respect to the accuracy of such information or its fitness for a particular purpose. Further, IHI expressly disclaims any obligation to update this report. By downloading this report, you agree, for yourself and on behalf of your organization, if any, that IHI expressly disclaims and shall have no exposure for any and all liabilities, losses, or damages of any type or nature, regardless of the theory pursuant to which the claim for such liabilities, losses, or damages are brought, and whether such liabilities, losses, or damages are direct, indirect, incidental, special, punitive, or consequential.

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