JONA Volume 49, Number 2, pp 86-92 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. THE JOURNAL OF NURSING ADMINISTRATION Evidence on Fall and Injurious Fall Prevention Interventions in Acute Care Hospitals Yunchuan (Lucy) Zhao, PhD, RN Marjorie Bott, PhD, RN Jianghua He, PhD Heejung Kim, PhD, RN Shin Hye Park, PhD, RN Nancy Dunton, PhD, RN Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to pa- tients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention prac- tices in acute care hospitals. The problem of adult inpatient falls and injurious falls in acute care hospitals has been a serious safety con- cern for patient care. In acute care hospitals, inpatient falls are the most common incidents reported by nurses and other healthcare team members. 1-4 In the United States, the average fall rate is about 3 to 5 falls per 1000 patient days with approximately 1 million annual falls in hospitals. Falls during hospitalization can have numerous negative consequences to patients and families, including fear of falling, depression, in- juries, reduced mobility and functional ability, and decreased independent living and quality of life. 4,5 Injuries resulting from inpatient falls can cause extra financial burden and decreased revenue to healthcare facilities. On average, injurious falls lead to an increased length of hospital stay by 6 to 12 days and an additional cost of $13,316. 6 Because the Cen- ters for Medicare and Medicaid Services no longer re- imburses hospitals for treatment of preventable injuries, including fall-related injuries, 7 not only will hospitals pay the extra cost for these fall-related injuries, hospi- tals will sustain revenue losses. Falls and falls-related injuries are listed as one of the nursing-sensitive care outcome measures by the National Quality Forum. 8 It is essential to prevent in- patient falls and related injuries so as to deliver high- quality care. To deliver high-quality care, nurse leaders in acute care hospitals need to have: a) the knowledge of specific risk factors associated with inpatient falls and injurious falls; b) common fall prevention inter- ventions; and c) potential strategies for effective fall and injurious fall prevention in acute care hospitals. The information presented hereinafter will assist nurse leaders to develop organizational policies and pro- grams that aim at effective fall and injurious fall pre- vention targeting adult inpatients. Factors Associated With Falls and Injurious Falls Evidence shows that inpatient falls and injurious falls are a complicated phenomenon that involves multiple factors, including intrinsic and extrinsic factors. 4,9,10 Intrinsic factors are patient-specific factors, and ex- trinsic factors include hospital organizational factors, nurse staffing, and nursing process factors. Intrinsic Factors Evidence demonstrates the association between ad- vanced age, and inpatient falls and injurious falls. 11-15 Among inpatient falls, about 50% occur in patients Author Affiliations: Assistant Professor (Dr Zhao), School of Nurs- ing, Boise State University, Idaho; Associate Dean, and Research and Associate Professor (Dr Bott), School of Nursing; and Associate Profes- sor (Dr He), Department of Biostatistics, University of Kansas, Kansas City; Assistant Professor (Dr Kim), College of Nursing, Yonsei Uni- versity, Seoul, South Korea; and Assistant Professor (Dr Park) and Research Professor (Dr Dunton), School of Nursing, University of Kansas, Kansas City. The authors declare no conflicts of interest. Correspondence: Dr Zhao, School of Nursing, Boise State University, 1910 University Dr, Mail Stop 1840, Boise, ID 83725 (lucyzhao@boisestate.edu). DOI: 10.1097/NNA.0000000000000715 86 JONA  Vol. 49, No. 2  February 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.