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Breaking the Fall

Johnson, Joyce E. PhD, RN, NEA-BC, FAAN; Veneziano, Teresa MSN, RN; Green, Jacqueline MSN, RNAPN-C; Howarth, Eileen BSN, RN; Malast, Tracey MSN, RN; Mastro, Kari MSN, RN, NEA-BC; Moran, Annlouise MSN, RN; Mulligan, Lori MSN, RN; Smith, Alicia MBA, RN

Journal of Nursing Administration: December 2011 - Volume 41 - Issue 12 - p 538–545
doi: 10.1097/NNA.0b013e3182378d53

Objective: The Helping Hands program is a nurse-directed falls prevention program designed to support a hospital-wide culture of safety and reduce harm from falls.

Background: Patient falls and the associated morbidity and mortality represent a significant risk for patients and healthcare facilities. Age-adjusted fatalities from falls increased significantly from 1993 to 2003. By 2020, the annual cost of injuries from falls is expected to exceed $40 billion.

Methods: Components of the Helping Hands falls prevention program worked synergistically to support the development of a culture of safety at Robert Wood Johnson University Hospital. The program consisted of nursing assessment of fall risk with the Johns Hopkins Fall Risk Assessment Tool; reviews of fall risk and intervention efficacy; creation of communication mechanisms, reporting processes, and change champion roles; engagement of patients and families in falls prevention; increased public awareness of fall risk through signage; nursing interventions; and utilization of nursing performance improvement analysts.

Results: Over 3 years, 65% (N = 7,900) of more than 12,000 patients assessed were at risk of falling. Most falls caused no or little harm, and at 3 years of follow-up, total falls decreased by 16.6 %, and severe falls accounted for 0.009 % (n = 2) of all falls.

Conclusions: The data offer a hopeful perspective on the role of nursing engagement in developing a hospital-wide culture of safety and protecting patients from permanent harm caused by fall events.

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Author Affiliations: Associate Dean, College of Nursing, University of Rutgers, New Brunswick, New Jersey (Dr Johnson); Senior Vice President and Chief Nursing Officer (Dr Johnson), Vice President, Clinical and Business Operations (Ms Veneziano), Interim Director, Nursing Education (Ms Green), Clinical Administrator (Ms Howarth), Assistant Vice President, Oncology and Surgery (Ms Malast), Assistant Vice President, Pediatrics, Perinatal and Neonatal (Ms Mastro), Director, Magnet Enculturation, Education and Quality (Ms Moran), Assistant Vice President, Medical and Critical Care (Ms Mulligan), Assistant Vice President, Perioperative Services (Ms Smith), Robert Wood Johnson University Hospital, New Brunswick, New Jersey.

The authors declare no conflict of interest.

Correspondence: Dr Johnson, Hospital Administration, Robert Wood Johnson University Hospital, One Robert Wood Johnson Place, PO Box 2601, New Brunswick, NJ 08903-2601 (

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© 2011 Lippincott Williams & Wilkins, Inc.