Hospital falls clinical practice guidelines: a global analysis and systematic review

Introduction
Hospital falls across the globe continue to rise and are responsible for significant patient harm and economic costs to health services. Clinical practice guidelines aim to reduce falls rates through the provision of up-to-date evidenced based recommendations. There is a need to identify and systematically evaluate hospital falls clinical practice guidelines on falls prevention and management across the globe.

Method
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and published protocol. Eight databases (CINAHL, MEDLINE, Embase, Cochrane CENTRAL, PEDro, Web of Science, Infobase of Clinical Practice Guidelines, and Espistemonikos) were searched from 1 January 1993 to 1 February 2024. The quality of the clinical practice guidelines was independently appraised by two reviewers with the Appraisal of Guidelines for Research and Evaluation Global Rating Scale and the Appraisal of Guidelines for Research and Evaluation Recommendation Excellence (AGREE-REX). The findings of the review were graded with the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Thematic synthesis was used to analyse the data.

Results
A total of 20 clinical practice guidelines on hospital falls prevention and management were included. Ten guidelines scored highly on the AGREE-REX. Comprehensive falls assessments, individual interventions, and multifactorial interventions were recommended consistently across the guidelines. Recommendations regarding falls risk screening were mixed but scored falls risk screening tools were no longer advocated. Guidelines provided limited detail on falls education methods for staff and patients as well as preventing falls in patients with delirium and dementia.

Conclusion
Although many high-quality clinical practice guidelines on hospital falls prevention and management are now available, their implementation into daily hospital practice is challenging and inconsistent. A standardised evidence-based approach to hospital falls prevention and management across a diverse range of patients is needed.