​A Healthcare Risk Control (HRC) member recently wrote asking for guidance on preventing falls in bathrooms in inpatient or residential treatment facilities. Specifically, the member sought guidance on limiting environmental factors that may contribute to increased fall risk.

HRC members can find general falls prevention guidance, including recommendations for addressing patient risk factors and performing environmental assessments, in the guidance article Falls. In addition, the Falls Management Training Program can be used to provide general falls-related education for staff, and Self-Assessment Questionnaire: Falls provides a basic assessment tool. For an assessment focusing on environmental risk factors, members may refer to the Home Safety Assessment, which includes a section on bathroom safety evaluation; some of the items are not relevant to facility settings, but many are. 

In addition, ECRI Institute spoke with the chair of the team that wrote the Facility Guidelines Institute's (FGI) 2014 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. FGI notes the following with regard to fall prevention in bathrooms:

• Placement of both horizontal and vertical grab bars reduces falls.
• Flooring surfaces contribute to falls.
• The spray and direction of the water contribute to falls.
• Shower curtains can contribute to falls, if the individual grabs them for stability. If grab bars are well placed, this can usually be avoided.
• Shower curtains are usually used to protect care staff providing assistance.

If staff observe water on the floor, other issues to consider include heating, ventilation, and air conditioning controls (because excess humidity can cause condensation on floors, making them slippery). Some states have specifications regarding shower curtain installations; these regulations are usually written from a perspective of preventing self-harm, but must be taken into account when looking at the environment to limit falls risk as well. 

A comprehensive environmental risk assessment is often the most effective approach. Both the FGI guidelines for residential care facilities and the Guidelines for Design and Construction of Hospitals and Outpatient Facilities contain tools for conducting such an assessment (called the resident safety risk assessment and the safety risk assessment, respectively). They can be found in section 1.2-3 (see particularly 1.2-3.4 and associated appendix material) in both sets of guidelines.     

The recommendations contained in Ask HRC do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.