Falls Prevention in Hospital: 15 Nursing Interventions That Reduce Falls and Injuries

Falls are one of the most common safety incidents in hospitals. Worldwide, the World Health Organization estimates that falls cause 684,000 deaths a year, making them the second leading cause of unintentional injury death after road traffic injuries. In hospital, a fall can mean a hip fracture, a head injury, a longer stay and loss of confidence.

Why patients fall in hospital

• Unfamiliar surroundings and getting up at night to use the toilet
• Delirium, dementia or confusion
• Postural (orthostatic) hypotension
• Medicines such as sedatives, antidepressants, antipsychotics, opioids, diuretics and blood pressure tablets
• Weakness, poor balance and previous falls
• Poor vision, poor footwear, incontinence and urgency
• Lines, catheters and drains that get in the way

Assessment, not just a score

UK NICE guidance advises that people aged 65 and over in hospital should not be assessed with a falls risk prediction score alone, but should have a multifactorial assessment of their individual risk factors, followed by actions for each one.

15 interventions that make a difference

1. Measure lying and standing blood pressure. A drop of 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing suggests postural hypotension.
2. Ask for a medicines review of drugs that increase falls risk.
3. Screen for delirium on admission and daily, and treat causes such as infection, pain, constipation and dehydration.
4. Keep the call bell, glasses, water and walking aid within reach.
5. Put the bed at its lowest height with the brakes on.
6. Check footwear: well-fitting slippers or non-slip socks, never bare feet or loose slippers.
7. Offer regular toileting, especially before sleep and on waking.
8. Light the way to the toilet at night and keep floors dry and clear.
9. Encourage safe mobility and early physiotherapy; prolonged bed rest weakens muscles.
10. Ensure eyesight and hearing aids are available and used.
11. Assess bed rails individually. They can prevent rolling out of bed but can cause injury if a confused patient climbs over them.
12. Place high-risk patients where staff can see them, or consider enhanced observation.
13. Involve families and carers in knowing what is normal for the patient.
14. Check vitamin D and bone health in people who have fallen or are at risk of fractures.
15. Share the falls plan at every handover.

What to do if a patient falls

• Do not rush to get the patient up. Check for injury, pain, consciousness and breathing first.
• If there is any suspicion of a hip, spinal or neck injury, keep them still and use flat lifting equipment according to local policy.
• If they hit their head, or if a head injury cannot be ruled out, start neurological observations. Be especially alert in patients on anticoagulants, who may need urgent imaging.
• Record observations, inform the medical team and the family, and complete an incident report.
• Review the falls plan to prevent another fall.

Related: Hip fracture nursing care · Physical restraint in hospital

Sources: World Health Organization falls fact sheet; NICE guideline NG249, Falls: assessment and prevention in older people and in people 50 and over at higher risk (2025); World guidelines for falls prevention and management for older adults (2022).