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An Evidencebased Approach to Fall Risk Assessment, Prevention, and Management: Lessons Learned

Poe, Stephanie S. MScN, RN; Cvach, Maria M. MS, RN, CCRN; Gartrell, Denise G. MS, RN; Radzik, Batya R. MS, RN, CRNP; Joy, Tameria L. BSN, RN

Journal of Nursing Care Quality:
Articles: Continuing Education

Nurses at an academic medical institution undertook a fall safety initiative. Using an evidence-based approach, they created a risk stratification tool, developed a comprehensive protocol, investigated fall-prevention products and technologies, and piloted the protocol and products/technologies before the full implementation. This article describes their journey and lessons learned along the way, the most compelling of which is the need for a simple, guided, and time-efficient approach to implementing the best practices into clinical care.

Author Information

Departments of Nursing Administration (Ms Poe), Medical Nursing (Mss Cvach and Joy), Radiology (Gartrell), and Neurosciences (Ms Radzik), The Johns Hopkins Hospital, Baltimore, Md.

Corresponding author: Stephanie S. Poe, MScN, RN, The Johns Hopkins Hospital, Department of Nursing Administration, 220, 600 N Wolfe St, Baltimore, MD 21287 (e-mail:

The authors acknowledge the hard work and dedication of the remaining members of the Fall Safety Task Force: Donna Brannan, MSN, RN; Mary Cooper, MS, RN; Vickie Singbeil, BSN, RN; and Harriet Straus, BSN, RN, CRRN.

Accepted for publication: May 27, 2004

© 2005 Lippincott Williams & Wilkins, Inc.