Improving Evidence-based Practices to Reduce Fall Injury in Progressive Care Unit (PCU)/Intermediate Care Unit (IMC) of The Hospital
Evidence-Based Interventions and Best Practices for Preventing Patient Falls in Hospital Progressive Care and Intermediate Care Units
Improving Evidence-Based Practices to Reduce Fall Injury in the Progressive Care Unit (PCU)/Intermediate Care Unit (IMC) of the Hospital
Falls are an inevitable and common occurrence among patients of all ages in healthcare organizations. However, they remain one of the most preventable events and pose a major threat to patient safety. These incidents create both clinical and economic burdens, including increased morbidity, reduced quality of life, and substantial healthcare costs (Locklear et al., 2024).
According to the U.S. Centers for Disease Control and Prevention (CDC) and other falls research:
- Fourteen million, or 1 in 4 Americans aged 65 and older, fall each year.
- Falls are the leading cause of fatal and non-fatal injuries among older adults.
- In 2021, falls caused 38,000 deaths among adults aged 65 and older.
- Emergency departments reported 3 million visits due to older adult falls.
- The cost of treating injuries caused by falls among older adults is projected to exceed $101 billion by 2030.
- More than half of older adults who fall receive hospital care.
- The estimated average annual cost per inpatient visit for fall injuries is $18,658, while emergency department visits average $1,112.
- Based on 2020 data, the total annual healthcare cost of non-fatal older adult falls reached $80 billion, up from $50 billion in 2015.
- Sixty-seven percent of fall-related costs are paid by Medicare, 4% by Medicaid, and 29% privately by patients and families (“Get the Facts on Fall Prevention,” 2025).
At the University of Florida (UF) Health Shands Hospital in Gainesville, Florida, there were 36 patient falls in three PCU/IMC units between July 2025 and April 2026. During the same period, the hospital recorded 363 total fall incidents, according to Courtney Bowen, Chairman of the Fall Injury Committee.
Fall Risk in PCU/IMC Settings
One hospital area where fall injuries are particularly prevalent is the Progressive Care Unit (PCU)/Intermediate Care Unit (IMC).
Intermediate care, also referred to as high-dependency care, step-down care, or progressive care, is designed for patients who no longer require intensive care unit (ICU) resources but still need more support than is available on a general medical-surgical floor (Case et al., 2024).
Patients in PCU/IMC are often clinically unstable despite being less critical. Many are older adults with conditions such as dementia or Alzheimer’s disease, which may contribute to sundowning syndrome—a condition characterized by confusion and agitation during evening hours. These factors significantly increase the risk of falls.
Causes of Falls: Intrinsic and Extrinsic Factors
Falls result from both intrinsic and extrinsic risk factors.
Intrinsic Factors:
- Advanced age
- History of previous falls
- Muscle weakness
- Gait and balance issues
- Poor vision
- Postural hypotension
- Chronic illnesses such as:
- Arthritis
- Stroke
- Diabetes
- Parkinson’s disease
- Dementia
- Fear of falling
Extrinsic Factors:
- Lack of stair handrails
- Poor stair design
- Absence of bathroom grab bars
- Dim lighting or glare
- Environmental clutter or tripping hazards
- Slippery or uneven surfaces
- Psychoactive medications (e.g., opiates, sedatives)
- Improper use of assistive devices
Healthcare providers, especially nurses, must remain vigilant in identifying and managing these factors (Locklear et al., 2024).
Common Fall Risk Assessment Tools
Several evidence-based assessment tools are used across healthcare settings:
Morse Fall Scale (MFS)
A widely used assessment tool that evaluates:
- History of falling
- Secondary diagnoses
- Use of ambulatory aids
- Mental status
AHRQ Fall TIPS Toolkit
A nurse-led, patient-centered intervention that creates individualized fall prevention plans using:
- Communication tools
- Visual alerts
- Patient and family engagement
Falls Risk Assessment Tool (FRAT)
Used to categorize patients into:
- Low risk
- Medium risk
- High risk
Scott Fall Risk Screen (SFRS)
An 11-item validated tool primarily used in long-term care settings (Norman, 2020).
Current Fall Prevention Strategies
To reduce fall injuries in PCU/IMC settings, multiple interventions are implemented.
The 5 P’s of Rounding:
- Pain
- Position
- Possessions
- Potty
- Pathway
This proactive rounding ensures:
- Patient needs are addressed regularly
- Personal belongings and call lights are within reach
- Environmental hazards are minimized
UF Health Shands Hospital Fall Prevention Bundle:
- Non-slip socks
- Gait belts
- Yellow armbands
- Door signage
- Bed or chair alarms
These precautions are maintained from admission through discharge.
Structured Rounding Schedule:
- Nurses round every two hours on even-numbered hours
- Patient Care Assistants (PCAs) round every two hours on odd-numbered hours
Additional Measures:
- Mandatory nursing care plan documentation in Epic
- Kamishibai (K-card) auditing for fall prevention compliance
- Smart Socks technology with pressure sensors to alert staff when patients attempt to stand independently
Research has shown Smart Socks can reduce fall rates from 4 per 1,000 patient days to 0 per 1,000 patient days (Dykes, 2024).
Conclusion
Falls remain one of the most common and preventable patient safety concerns in healthcare settings.
Although falls may never be eliminated entirely, healthcare systems can significantly reduce fall-related injuries by implementing:
- Comprehensive risk assessments
- Evidence-based prevention bundles
- Proactive rounding
- Environmental safety strategies
- Advanced technologies
- Continuous staff education and auditing
In Progressive Care Units and Intermediate Care Units, where patients are especially vulnerable, strengthening evidence-based fall prevention practices is essential to improving patient outcomes, reducing healthcare costs, and enhancing overall quality of care.
Through consistent, multidisciplinary commitment, the goal of minimizing fall injury rates is both realistic and achievable.
References
Case, A., Hockberg, C., & Hager, D. (2024). The role of intermediate care in supporting critically ill patients and critical care infrastructure. National Library of Medicine.
Dykes, P. (2024). The ongoing journey to prevent patient falls. Agency for Healthcare Research and Quality.
“Fall Prevention for Seniors.” (2025). Seabury Article.
“Fall TIPS: A Patient-Centered Fall Prevention Toolkit.” (2026). Agency for Healthcare Research and Quality.
“Get the Facts on Fall Prevention.” (2025). National Council on Aging.
Locklear, T., Kontos, J., Brock, C., et al. (2024). Inpatient falls: Epidemiology, risk assessment, and prevention measures: A narrative review.
Norman, K. (2020). Evaluation of predictive accuracy of fall risk tools in residential long-term care. Cambridge University Press.
