Reducing Falls in Older Adults Using Antipsychotics During Hospitalization: Implementation of a Fall Risk Screening and Prevention Protocol

BACKGROUND: Falls are a major global health concern for older adults, causing about 684,000 deaths and 37.3 million injuries worldwide each year. Older adults prescribed antipsychotic medications are at high risk due to side effects that increase fall likelihood. These patients have a 1.5 higher risk of falling; typical antipsychotics increase risk by 48% and atypical antipsychotics by 72%. Preventing falls in this group is essential to reduce injuries, fatalities, and healthcare costs.

LOCAL PROBLEM: The project was conducted on a unit primarily serving patients aged ≥65 with multiple comorbidities. Frequent falls among older adults prescribed antipsychotics led to the implementation of a standardized fall risk screening and prevention protocol for this high-risk group. The primary aim was to achieve at least 50% adherence to fall risk assessments and interventions during a 90-day period from mid-February to mid-May 2025.

METHODS: The project used the Evidence-Based Practice Improvement model. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was chosen for its predictive validity. Patients prescribed antipsychotics were screened with the JHFRAT at admission. Screening and intervention adherence were audited. Staff received targeted education on antipsychotic risks and proper JHFRAT completion.

INTERVENTIONS: Routine JHFRAT screening informed risk-based fall prevention, supported by staff education, reminders, reference materials, and PDSA-driven updates.

RESULTS: Of the 262 patients admitted to the unit aged ≥ 65, 66 (25%) patients were prescribed antipsychotics and screened using JHFRAT. 33 (50%) patients screened by staff were in adherence to JHFRAT scored correctly and 64 (97%) received appropriate fall prevention interventions. Falls with injury decreased from four to one after implementation. Fall-related costs declined by $129,052.

CONCLUSIONS: Standardized fall risk screening for older adults on antipsychotics reduced falls and costs. However, sustainability remains a challenge, with recent declines in screening rates after implementation ended. Future efforts should focus on workflow integration, ongoing staff education, and periodic audits.