Step by step: How TMH is building a culture of patient fall prevention
September 21, 2026
For many hospital patients, especially those recovering from surgery, managing illness or adjusting to new medications, something as simple as getting out of bed can become unexpectedly difficult.
According to national hospital data, about 2% of hospitalized patients experience a fall. Of those falls, approximately one in four results in an injury, and about 10% result in a serious injury. While falls can have serious consequences, identifying risks early can help care teams take proactive steps to keep patients safe.
At Tallahassee Memorial HealthCare (TMH), fall prevention is part of everyday care. Through proactive assessments, technology, staff education and continuous quality improvement, TMH teams work together to create a safer environment for patients.
Identifying Fall Risks Early
Fall prevention begins long before a patient attempts to stand. Because a patient's risk can change throughout their stay, TMH care teams rely on structured tools to identify and communicate risk early:
- Evidence-based fall screenings: Care teams evaluate patients upon admission, every shift and if a patient should experience a fall, using the Morse Fall Scale for adults, the Humpty Dumpty Fall Scale for pediatric patients and the Edmonson Psychiatric Fall Risk Assessment Tool at the Tallahassee Memorial Behavioral Health Center.
- Visual identifiers: Room door signs alert every team member when a patient is at higher risk for falling.
- Fall prevention tips posters: Bedside posters outline tailored safety measures and prevention tips for the patient, family and care team. Pediatric units use age-specific posters to address unique risks for younger patients.
Creating a Safer Environment With Technology and Bedside Care
Preventing falls is built into routine care. Nursing teams conduct regular rounds to check on patients, ensuring call lights are within reach, nonskid socks are on, beds are locked in a low position and walkways remain clear of clutter.
When patients need help moving, care teams often provide dedicated equipment like standing and transfer aids, gait belts and walkers to help support the patient’s mobility and reduce the risk of falls.
Technology adds another layer of protection. TMH has rolled out chair alarms across the Medical-Surgical division. Connected directly to the nurse call system, these alarms alert staff instantly if a high-risk patient attempts to stand without assistance.
Learning From Every Fall
TMH uses patient fall data and standardized review processes to identify trends, contributing factors and opportunities to strengthen fall prevention. Post-fall huddles provide care teams with a structured opportunity to review relevant circumstances and gather insights that can inform patient safety efforts.
Information from these reviews is shared with department leaders and nursing administration for further analysis. Looking at this information collectively helps teams identify patterns, evaluate current practices and determine where additional strategies or process improvements may strengthen fall prevention across the organization.
When appropriate, interdisciplinary teams conduct a root cause analysis (RCA) in collaboration with nursing leadership and organizational improvement leaders following a fall that results in a major injury. These reviews help teams look beyond the individual event to identify contributing factors and opportunities to strengthen processes.
Fall prevention efforts have also included a Lean Six Sigma Green Belt project, a data-driven approach to identifying process gaps and testing improvements. These quality improvement efforts help TMH continually evaluate and refine clinical workflows to make care safer for patients.
Keeping Safety at the Forefront
Creating a culture of safety requires ongoing education. Throughout the year, TMH's clinical education team facilitates a month-long campaign across the Medical-Surgical division, focusing on evidence-based strategies and hands-on equipment training.
Patients and families are also critical partners. Illness, surgery and medications can temporarily affect balance, making independent movement unsafe. Care teams actively encourage patients to use their call light whenever they need help getting up, and families can help by reinforcing these precautions.
We Care Everywhere
Preventing patient falls requires continuous attention, clear communication and teamwork across the organization. At TMH, every safety check, patient conversation and post-fall review provides another opportunity to improve and help prevent future falls.
Because when it comes to patient safety, every step matters.
Learn more about how TMH drives quality and patient safety at TMH.ORG/WeCareEverywhere.
