Purpose and scope
This best practice guideline (BPG) focuses on the prevention of falls and fall injuries in all adults at risk for falls – including those living in the community – who are receiving care from nurses or other health-care providers. Evidence reviewed for this guideline included studies conducted in three main health-care settings:
- community (including primary care and home care)
- long-term care
Registered Nurses’ Association of Ontario. (2017). Preventing Falls and Reducing Injury from Falls (4th ed.). Toronto, ON: Registered Nurses’ Association of Ontario.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Preventing Falls and Reducing Injury from Falls.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: Screen all adults to identify those at risk for falls. Conduct screening as part of admission processes, after any significant change in health status, or at least annually. Screening should include the following approaches:
- identifying a history of previous falls;
- identifying gait, balance, and/or mobility difficulties; and
- using clinical judgment.
Recommendation 1.2a: For adults at risk for falls, conduct a comprehensive assessment to identify factors contributing to risk and determine appropriate interventions. Use an approach and/or validated tool appropriate to the person and the health-care setting.
Recommendation 1.2b: Refer adults with recurrent falls, multiple risk factors, or complex needs to the appropriate clinician(s) or to the interprofessional team for further assessment and to identify appropriate interventions.
Recommendation 2.1: Engage adults at risk for falls and fall injuries using the following actions:
- explore their knowledge and perceptions of risk, and their level of motivation to address risk;
- communicate sensitively about risk and use positive messaging;
- discuss options for interventions and support self-management;
- develop an individualized plan of care in collaboration with the person;
- engage family (as appropriate) and promote social support for interventions; and
- evaluate the plan of care together with the person (and family) and revise as needed.
Recommendation 2.2:Provide education to the person at risk for falls and fall injuries and their family (as appropriate) in conjunction with other falls prevention interventions. This includes providing information about risk for falls, falls prevention, and interventions.
Ensure that the information is provided in a variety of formats and in the appropriate
Recommendation 2.3: Communicate the person’s risk for falls and related plan of care/interventions to the next responsible health-care provider and/or the interprofessional team at all care transitions to ensure continuity of care and to prevent falls or fall injuries.
Recommendation 2.4:Implement a combination of interventions tailored to the person and the health-care setting to prevent falls or fall injuries.
Recommendation 2.5: Recommend exercise interventions and physical training for adults at risk for falls to improve their strength and balance. Encourage an individualized, multicomponent program/ activity that corresponds to the person’s current abilities and functioning.
Recommendation 2.6: Collaborate with prescribers and the person at risk for falls to reduce, gradually withdraw, or discontinue medications that are associated with falling, when the person’s health condition or change in status allows. This includes the following actions:
- identify polypharmacy and medications that increase risk for falls;
- conduct a medication review, or refer to an appropriate health-care provider and/or the prescriber; and
- monitor for side effects of medications known to contribute to risk for falls
Recommendation 2.7: Refer adults at risk for falls or fall injuries to the appropriate health-care provider for advice about vitamin D supplementation.
Recommendation 2.8: Encourage dietary interventions and other strategies to optimize bone health in adults at risk for falls or fall injuries, particularly those at risk for fracture. Refer to the appropriate health-care provider for advice and individualized interventions.
Recommendation 2.9: Consider hip protectors as an intervention to reduce the risk of hip fracture among adults at risk for falls and hip fracture. Review the evidence, potential benefits, harms, and barriers to use with the person to support individualized decisions.
Recommendation 3.1: After a person falls, provide the following interventions:
- conduct a physical examination to assess for injury and to determine the severity of any fall injuries;
- provide appropriate treatment and care;
- monitor for injuries that may not be immediately apparent;
- conduct a post-fall assessment to determine factors that contributed to the fall;
- collaborate with the person and the interprofessional team to conduct further assessments and determine appropriate interventions; and
- refer the person to the appropriate health-care provider(s) for physical rehabilitation and/or to support psychological well-being (as needed).
Recommendation 4.1: Educational institutions incorporate content on falls prevention and injury reduction into health-care education and training programs.
Recommendation 4.2: Health-care organizations provide ongoing organization-wide education to all staff in conjunction with other activities to help prevent falls and reduce injuries among persons in
Recommendation 5.1: To ensure a safe environment:
- implement universal falls precautions, and
- identify and modify equipment and other factors in the physical/structural environment that contribute to risk for falls and fall injuries.
Recommendation 5.2: Organizational leaders, in collaboration with teams, apply implementation science strategies to enable successful implementation and sustainability of falls prevention/injury reduction initiatives. This includes identifying barriers and establishing formalized supports and structures within the organization.
Recommendation 5.3: Implement rounding as a strategy to proactively meet the person’s needs and prevent falls.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
Falls search strategy.pdf (194k)
Current edition published: September 2017 with 2002, 2005, 2011 revisions.
About the next edition
The Registered Nurses' Association of Ontario (RNAO) is developing a fifth edition of this best practice guideline (BPG), with the working title Prevention of Falls and Reducing Injury from Falls. The anticipated publication date is 2025.
This new edition will replace RNAO's BPG Prevention of Falls and Reducing Injury from Falls (2017) and Prevention of Falls and Fall Injuries in the Older Adult (2002, 2005 and 2011).