Falls1.pdf

January-February 2021 • Vol. 30/No. 128

Susan B. Fowler, PhD, RN, CNRN, FAHA, is Nurse Scientist, Center for Nursing Research,
Orlando Health, Orlando, FL.

Ellen S. Reising, MSN, APRN-CNS, ACCNS-AG, RN-BC, is Clinical Nurse Specialist,
Advanced Practice Nursing & Research, Dr. P. Phillips Hospital – General Surgery Unit,
Orlando, FL.

A Replication Study of Fall TIPS
(Tailoring Interventions for Patient

Safety): A Patient-Centered Fall
Prevention Toolkit

Susan B. Fowler
Ellen S. Reising

T
he Agency for Healthcare
Research and Quality (AHRQ,
n.d.) defined a fall as a sud-

den, unintended, uncontrolled
down ward displacement of a pa –
tient’s body to the ground or other
object. This includes situations in
which a patient falls while being
assisted by another person but
excludes falls resulting from a pur-
poseful action or violent blow. The
National Quality Forum (2015)
identified five levels of injury from
falls:
• None – patient had no injuries

(no signs or symptoms)
• Minor – required application of

a dressing or ice; cleaning of a
wound; limb elevation; topical
medication; pain, bruise, or
abrasion

• Moderate – needed suturing,
application of surgical tape
strips/skin glue; splinting; mus-
cle/joint strain

• Major – required surgery, cast-
ing, traction; consultation for
neurological (basilar skull frac-
ture, small subdural hematoma)

or internal injury (rib fracture,
small liver laceration); patients
with coagulopathy who receive
blood products

• Death – resulting from injuries
sustained from fall, but not from
physiologic events causing the
fall
Fall risk is assessed on all patients

admitted to most facilities. The
Morse Fall Scale is used widely in
many healthcare settings and
included in some risk models for
inpatient falls (Choi et al., 2018). At
the study institution, this scale is
used for risk assessment on admis-
sion, during the dayshift assessment,
when a change in the patient’s con-
dition occurs, upon transfer to
another unit, and after a fall.

Standard or universal fall preven-
tion identified by the AHRQ (2018)
includes specific interventions,

such as familiarizing the patient
with the environment and having
the patient demonstrate call light
use. The call light is maintained
within the patient’s reach, as are
personal possessions. Sturdy hand –
rails should be present in the bath-
rooms, patient room, and hallway.
The bed is in low position and bed
brakes are locked; the bed can be
raised to a comfortable height when
transferring the patient. Wheelchair
wheel locks also should be used
when the wheelchair is stationary.A
night light or supplemental lighting
is needed. The patient care area
should be uncluttered, with surfaces
kept clean and dry. Staff should fol-
low safe patient handling practices.
Adult patients may be offered assis-
tance with toileting every 2 hours as
appropriate. If a patient is identified
as high risk for fall, a yellow wrist-

Instructions for
CNE Contact Hours

MSN J2103
Continuing nursing education (CNE)

contact hours can be earned for
completing the evaluation associated

with this article. Instructions are available
at amsn.org/journalCNE

Deadline for submission:
February 28, 2023
1.1 contact hours

The Fall TIPS (Tailoring Interventions for Patient Safety) Toolkit pro-
vides individualized, patient-centered fall prevention measures. In a
study exploring the toolkit’s adoption and its impact on patient
knowledge of fall risk factors and interventions, fall rates, and injury
rates, results demonstrated increased perceived patient knowledge
of patient fall risk and related prevention strategies. An overall
decrease in fall rates over time supported use of innovative, individ-
ualized fall prevention strategies.

January-February 2021 • Vol. 30/No. 1 29

band imprinted with Fall Risk is
placed on the patient.

For the period September 2016-
August 2017, 36 patient falls oc –
curred in the study unit. Three falls
occurred on average each month
(range one to six). Despite use of
standard high-risk fall prevention
strategies such as a yellow armband
and non-skid socks, falls and falls
with injury continued. A research
team was formed to investigate a dif-
ferent approach to fall prevention.

Purpose
The primary purpose of this

research was to replicate a pub-
lished study (Dykes et al., 2017) to

determine the suitability of a
patient-centered fall prevention
tool and its impact on patient
knowledge of fall risk factors and
prevention interventions, overall
fall rates, and falls with injury. A
secondary objective was to evaluate
ease of use of the patient-centered
fall prevention tool and the need
for modifications.

Review of the Literature
Dykes and colleagues (2017) de –

veloped and pilot tested a patient-
centered, individualized approach
to fall prevention. Inter ventions
were tailored to individual patient
needs, including history of falls,

medication side effects, use of walk-
ing aid, intravenous-related equip-
ment, unsteady gait or walk, and
cognition issues such as forgetting
or resistance to calling for assis-
tance. The approach consisted of a
bed poster that included fall risk
assessment items on the left side
and fall prevention interventions
on the right. The bed poster focused
on risk of harm, fall risks, and fall
interventions and was hung at the
bedside (see Figure 1). Dykes and
colleagues suggested a patient and
family, if possible, must be included
in the steps of the fall prevention
process.

Following the Tailoring Interven –
tions for Patient Safety (TIPS) inter-
vention used by Dykes and coau-
thors (2017) at two facilities, patient
knowledge of fall risk and preven-
tion based on two statements signif-
icantly increased (p=0.001-0.31).
The mean fall rate comparing 6
months of data before and after
intervention decreased from 3.28 to
2.8; fall injury rates decreased from
1.00 to 0.54. Positive results subse-
quently have been replicated at
other hospitals in the Partners
HealthCare system and communi-
cated through a formalized Fall TIPS
Collaborative (Dykes et al., 2019).
The website for the Collaborative
(www.falltips.org) provides the
toolkit, webinars, and implementa-
tion materials.

Because this study’s focus was to
replicate previously published re –
search, a comprehensive literature
review on fall prevention was not
conducted. A search was conducted
in CINAHL for 2017-2020, focusing
on fall prevention, hospital (set-
ting), and systematic reviews. Ten
articles were found but most
focused on fall prevention after hos-
pital discharge or older adults,
resulting in one applicable study
discussed below.

Avanecean and colleagues (2017)
conducted a systematic review of
the effectiveness of patient-centered
interventions on falls in the acute
care setting. Five randomized con-
trolled trials were included in the
narrative synthesis. Three of these
studies demonstrated a reduction in
fall rates, all using personalized care

Background

Generalized standard interventions based on level of risk are current prac-
tices for fall prevention, but not individualized. Dykes and colleagues
(2017) developed and tested a patient-centered, individualized approach
to fall prevention using an 11 x 17-inch wall poster to engage patients/
families in fall prevention at the bedside.

Aim

Replicate the study by Dykes and coauthors (2017) on a medical teleme-
try unit, exploring adoption of a patient-centered fall prevention tool
and its impact on patient knowledge of fall risk factors and interventions,
fall rates, and injury rates.

Method

A pre- and post-intervention design was used to compare patients’ per-
ceived knowledge and actual fall rates before and after implementating
the tool and processes. Thirty patients were interviewed before the study
and at 1-, 3-, and 6-month time points during implementation (N=120).
Number and rates of falls per 1,000 patient days were calculated. Audits
were completed randomly to monitor adherence to the process.

Results

Patients were more knowledgeable about falls at months 1, 3, and 6 com-
pared to pre-intervention (p=0.001-0.05). Fall rates fluctuated over the 6-
month study, with overall reduction from 3.3% (pre-) to 1.9% (post-).
Staff was 85% adherent with use of the laminated poster, with adherence
increasing over time.

Limitations and Implications

Findings are limited to one hospital and one medical telemetry unit.
Results support the potential for a best practice change. Plans are to dis-
seminate this new process to other patient units.

Conclusion

Replication in patient units outside the medical telemetry arena is suggested.

A Replication Study of Fall TIPS (Tailoring Interventions for Patient Safety): A Patient-Centered Fall Prevention Toolkit

January-February 2021 • Vol. 30/No. 130

plans and patient-centered educa-
tion. One of the three trials is the
focus of this replication study.

Recently, LeLaurin and Shorr
(2019) conducted a review of the lit-
erature on preventing falls in hospi-
talized patients and found most
publications on this topic addressed
quality improvement projects. Strat –
egies used singly or in combination
included fall risk identification,
alarms, sitters, intentional round-
ing, patient education, environ-
mental modifications, physical
restraints, and patient use of non-
slip socks. Intentional rounding
and patient education involved
interaction with the patient, but
this was limited due to cognition.
Authors suggested a need for
focused research on fall prevention
strategies.

Ethics
The Institutional Review Board

approved the study at the site with

expedited status. A waiver of con-
sent documentation was granted.
Investigators provided patients with
a study information sheet explain-
ing the study and participant
involvement. No patient identifiers
were noted when patients were
asked two questions about fall risk
and prevention.

Sample Selection
The poster was used with all

patients on the medical telemetry
unit at a 237-bed community hospi-
tal over 6 months (March-August
2018). Average daily census was
approximately 30 patients during
this period. Four convenience sam-
ples of 30 patients each were chosen
for interviews before the interven-
tion and at 1 month, 3 months, and
6 months during the intervention
period (N=120). Patients had to be
alert, oriented, and English- or
Spanish-speaking to be included in
the interview process.

Design and Method

Design
The study used a pre- and post-

intervention design.

Intervention
The intervention involved use of

a risk assessment poster and inter-
vention guide, as well as nursing
action, to engage the patient and
family in discussions of fall risk and
prevention. The tool was a laminat-
ed copy of a poster (11 x 17 inches).
The poster, which was an exact
copy of the one used by Dykes and
associates (2017), was hung on the
wall opposite the patient’s bed for
visibility. It was removed easily
from the wall to be held by nurses
during discussion of fall risk and
prevention with the patient and
family. The laminated surface
allowed nurses to write and remove
notes made in nonpermanent
marker. Nurses updated the poster

FIGURE 1.
Fall Risk Factor and Intervention Poster

Source: Brigham and Women’s Hospital. Used with permission.

January-February 2021 • Vol. 30/No. 1 31

based on the patient’s current con-
dition (e.g., peripheral intravenous
catheter discontinued). They re –
viewed the information on the tool
with the patient at least once dur-
ing each 12-hour shift.

Patients were asked to indicate
their level of agreement with the
same two statements described by
Dykes and colleagues (2017) regard-
ing knowledge of current fall risk
and prevention: (a) I am able to
identify my risks for falling, and (b)
I know what I need to do to prevent
myself from falling. A 5-point Likert
scale was used (1=strongly disagree,
5=strongly agree). When statements
were combined, range of scores was
2-10.

Additionally, audits of documen-
tation adherence on the poster were
conducted twice weekly by mem-
bers of the study team for the first 3
months of the intervention (March-
May). Five data items were collect-
ed: room/bed number, patient
name, current date and time, iden-
tification of risk factors, and nota-
tion of fall prevention plan. All
items except the room/bed number
were used in the Dykes and coau-
thors (2017) study. In April and
May, there was a decrease in adher-
ence to use of the Fall TIPS tool;
therefore, managers then mandated
the Falls TIPS poster be completed
by 11:00 a.m. on all patients.
Clinical nurses strategized to build
completion of the Falls TIPS tool
into their workflow to meet unit
expectations.

Fall and fall injury rates were
obtained for 3-6 months before
implementing the patient-centered
fall prevention intervention. After
written permission was obtained to
use the fall risk assessment poster
and intervention guide, focused
staff education materials were
shared with all nursing staff on a
medical telemetry unit. Topics
included the benefits of integrating
an individualized fall risk assess-
ment and intervention with the
current standard or universal inter-
ventions for a comprehensive,
patient-centered fall prevention
program. Current fall rates and fall
reduction goal statements also were
reviewed with the staff. Small

groups of staff were educated at a
time, providing more one-to-one
time to review a case study. The
clinical nurse specialist (CNS) held
additional small group education
workshops over 2 weeks before
implementation for nursing staff
who needed or wanted further
training. Sessions took approxi-
mately 15 minutes and included a
case study that allowed nurses to
apply the Falls TIPS tool. Role play
was used to demonstrate nurse-
patient interactions. Team members
unable to attend workshops and
any newly hired staff were given
individual education by the CNS
using the same format. Study refer-
ence binders were available at each
nurses’ station as an immediate
resource.

Before the start of the study, a
convenience sample of 32 alert, ori-
ented patients was approached by
investigators with a study informa-
tion sheet to seek their willingness
to participate in the study. Thirty
who agreed then were asked to
respond to two Likert-style state-
ments about knowledge of fall risk
factors before intervention imple-
mentation.

Following the initial question-
naire collection period, all patients
were assessed each shift using the
current process of the Morse Fall
Scale followed by individualized
teaching to patient and family (if
present) using the patient-centered
Fall TIPS prevention tool. Investi –
gators monitored adherence to doc-
umentation on the poster using the
audit form three times a week
Monday through Friday (patient
name, date, risk factors, prevention
plan).

After the first 30-day implemen-
tation period, an additional con-
venience sample of 30 alert, orient-
ed patients was approached at 1
month, 3 months, and 6 months
with a study information sheet to
assess willingness to participate in
the study. Each sample was asked to
respond to the same two Likert-type
statements about knowledge of fall
risk factors. Data collection occur –
red over 2 weeks for each group.

Team meetings were scheduled
to evaluate project implementation:

ease of use of patient-centered fall
prevention tool, issues with use,
and needed modifications. Data
(patient knowledge and fall rates
and fall injury rates) were analyzed
3-6 months following implement-
ing the patient-centered fall risk
assessment and intervention poster.
Adherence to documentation on
the patient-centered fall risk and
intervention poster was captured
with a percentage. For example, if
three of five items were document-
ed, adherence would be 60%. An
independent t-test was used to com-
pare pre- and post-scores of patient
knowledge of falls. Fall rates and fall
injury rates were based on 1,000
patient days.

Findings
Overall adherence to documen-

tation on the fall risk assessment
and intervention poster in the study
period was 84%, with improve ment
over time. Initial adherence of 45%
steadily increased to 100% at the
end of the study. In 183 of 259
observations, documentation on
the poster was 100% completed
with the five key elements of the
patient’s name, date and time, iden-
tification of risk factors, and nota-
tion of an individualized preven-
tion plan.

In general, patients perceived
they were knowledgeable about
their risk for falls and how to pre-
vent a fall throughout the study
and the lead-in period (pre-inter-
vention). The mean score for state-
ment 1 (identifying fall risk)
increased from 4.13 to 4.6 at 1
month; it remained largely un –
changed at 3 and 6 months (4.57
and 4.47, respectively). The mean
for statement 2 (how to prevent a
fall) increased from 3.97 to 4.67 at 1
month; it also remained mostly
unchanged at 3 and 6 months (4.53
and 4.7, respectively). Patients’ per-
ceived knowledge of both state-
ments significantly increased after
intervention (see Table 1).

During the first month of using
the patient-centered Falls TIPS tool
(March 2018), no falls occurred in
the study unit. The fall rate
increased during April-June 2018

A Replication Study of Fall TIPS (Tailoring Interventions for Patient Safety): A Patient-Centered Fall Prevention Toolkit

January-February 2021 • Vol. 30/No. 132

but not to the rate before imple-
mentation (see Figure 2). Following
the decision to incorporate tool
completion into daily nurse work-
flow by 11:00 a.m. in June, the fall
rate decreased again in July and
August (see Figure 2). At 1 month
following study completion, the fall
rate remained low; this may be
attributed to the standardized work-
flow process using the fall risk
assessment and intervention poster.

Only two falls with major injury
occurred in the 7 months before
study implementation. However,
one of those falls escalated in sever-
ity because of anticoagulant med-
ication used for venous throm-
boembolism prophylaxis. Through –
out the study period (March-August
2018) and 24 months afterward
(September 2018-August 2020), no
falls with major injury occurred in
the study unit.

Discussion
Adherence (84%) to use of the

patient-centered Fall TIPS tool was
comparable to findings noted in the
study by Dykes and colleagues
(2017) (82% & 91%). Adherence to
documentation indicated poster use
increased through the course of the
study partially because its use
became part of the workflow for
nurses and nursing assistants.
Continuous communication about
number of falls, fall rates, and falls
with injury supports awareness and
sustained use of the patient-cen-
tered Fall TIPS tool. Huddles and

Gemba or other communication
boards provide verbal and visual
opportunities for communication
about falls.

Patients’ perceived ability to
identify risk and knowledge of safe-
ty actions was already high before
the study. Perceived identification
of risk and knowledge of fall pre-
vention increased slightly at each
timeframe (1 month, 3 months, 6
months), but differences were not
statistically significant. However,

the baseline increase compared to
1-month, 3-month, and 6-month
survey periods was statistically sig-
nificant (p=0.001-0.05). This find-
ing was similar to that of Dykes and
coauthors (2017), although patients
at baseline for this study had higher
perceived knowledge. Patients and
family members should be educated
on their fall risk based on findings
from fall risk assessments.

Dykes and colleagues (2017)
identified barriers to implementa-

TABLE 1.
Comparisons of Means (t-test)

Pre (n=30 patients)
Compared to 1 Month

(n=30 patients)

Pre (n=30 patients)
Compared to 3 Months

(n=30 patients)

Pre (n=30 patients)
Compared to 6 Months

(n=30 patients)

Question 1
(identify fall risk)

-2.16 (58)
p=0.035*

-2.00 (58)
p=0.05*

-2.27 (58)
p=0.034*

Question 2
(knowledge of prevention)

-3.46 (58)
p=0.001*

-2.67 (58)
p=0.013*

-4.00 (58)
p=0.000*

Combined questions 1 & 2 -3.43 (58)
p=0.05*

-2.57 (58)
p=0.013*

-3.66 (58)
p=0.001*

*p<0.05 level of significance FIGURE 2. Fall Rates Before, During, and Immediately After Study Period Fall Rate 7 6 5 4 3 2 1 0 3.7 5.3 1.8 2.1 2.1 3.9 3.3 1.1 1.1 4.4 1.1 0 O ct -1 7 N o v- 1 7 D e c- 1 7 Ja n -1 8 F e b -1 8 M a r- 1 8 A p r- 1 8 M a y- 1 8 Ju n -1 8 Ju l- 1 8 A u g -1 8 S e p -1 .1 Fall Rate Linear (Fall Rate) Staff education. Fall TIPS tool implementation Mandatory completion of tool by 11:00 a.m. rounds January-February 2021 • Vol. 30/No. 1 33 tion of the Fall TIPS assessment dur- ing their investigation. One obsta- cle was decreased awareness or unawareness of the new guideline or evidence. The poster seemed to increase awareness of falls in this study, as evidenced by discussions at shared governance meetings. Additionally, it highlighted the complexity of falls and increased the need for a team approach involving the patient, family, clini- cal nurse, nursing assistant, and nurse leaders. Fall risk and preven- tion were reported during shift handoff by all nursing staff. Another barrier identified by Dykes and associates (2017) was decreased familiarity with the tool. Staff in the current study lacked familiarity with the assessment but were educated on its use before and throughout this research. Limited self-efficacy also was noted by staff who were unsure how to use the tool or forgot how to use it. Adherence increased over time, not only for properly writing on the assessment but also for using it in conversation with patients and families. The barrier of lack of out- come expectations (Dyke et al., 2017) was evident in the current study through staff members who thought the assessment would decrease the number of falls. However, the evaluation was only one part of a fall prevention plan; other factors have to be considered, such as rounding and toileting. Other simple barriers were iden- tified to use of the laminated Fall TIPS assessment in practice. Often dry erase markers were not available to staff to document on the poster. The grade of the laminate material is important as cheaper items make it harder to maintain integrity of the poster, with repeated use leav- ing it looking dirty. Using high- grade laminate and hanging fresh wall posters every 6 months is sug- gested to ensure a clean surface between patients. Other considera- tions were the poster’s location in the patient room and materials to adhere it to the wall/board. The poster must be visible from the patient bed; however, this was not always possible because of existing items on the walls, so sometimes alternative locations (e.g., bath- room door) were used. The hooks also were problematic. The hooks should allow the poster to be removed and replaced easily when using it for patient teaching. If not, the hooks pull off the wall and leave no place for the poster to hang. This affects nurses’ ability to adhere to the process. Limitations Study results are limited due to a single patient care unit with a focus primarily on medical patients. Generalizability to other specialty units is not possible. The 120 patients interviewed before and during the study were a conven- ience sample. It is unknown if other patients had the same or different perceived knowledge about falls and prevention strategies. Although the poster was visually available in patients’ rooms, frequency of its use in conversation with patients and families is unknown. Recommendations for Future Research Study of the patient-centered Fall TIPS assessment in other patient care areas, including critical care, is warranted. A standardized approach to overcome barriers before and throughout an investigation using the assessment should be developed to limit variability. Future research might include family members’ knowledge of personal fall risks and related precautions to address fami- ly-centered care fully. Dykes and coauthors (2019) suggested clinical nurses be involved in redesigning their workflow to engage patients and families in fall prevention using the TIPS assessment. A study com- paring the effectiveness of various workflow redesigns thus may add to understanding of best practices. As new fall prevention strategies are developed, they should be added to a fall prevention program that includes the TIPS assessment to evaluate processes and outcomes. Nursing Implications The Health Research & Educ - ational Trust (2017) has promoted the Fall TIPS assessment through the hospital improvement innova- tion network as an individualized, patient-centered fall prevention measure. The patient-centered Fall TIPS assessment may not be appro- priate for every patient care unit based on the patient population. The poster often is used interactive- ly with patients. Confused patients may not understand the informa- tion. Still, staff can use the bottom purple area to designate patients as impulsive, in need of a chair or bed alarm, or choosing not to follow fall precautions. This communicates the patient’s need for close constant observation when out of bed. The assessment increased aware- ness of falls, focusing on multifac- eted fall prevention efforts for staff and leaders. Outcomes associated with a fall prevention program are not only decreased falls. A signifi- cant outcome might be decreased falls with injury, as suggested by Dykes and colleagues (2017). The current study unit also realized this outcome during the research peri- od. Findings showed success and potential for a best practice change. Changes should be based on best evidence, clinician expertise, and patient preferences – the three com- ponents of evidence-based practice (Melynk & Fineout-Overholt, 2015). All three factors were relevant to this investigation. Best evidence included evidence from research (Dykes et al., 2019; Dykes et al., 2017), as well as fall data. Clinician expertise was the knowledge and experience of clinical nurses and nurse leaders in fall prevention and logistics of implementing fall pre- vention strategies. Patient prefer- ences focused on their understand- ing, recognition, and behaviors associated with their fall risk and prevention. Dissemination of study findings to other patient care units is being done with possible oppor- tunities to use the tool outside the medical-surgical unit. To date, two additional units have adopted the fall risk assessment poster and inter- A Replication Study of Fall TIPS (Tailoring Interventions for Patient Safety): A Patient-Centered Fall Prevention Toolkit vention guide at the same institu- tion; five other units are incorporat- ing the poster and guide at another facility in the system. Conclusion Study results demonstrated in - creased perceived patient knowledge of patient fall risk and related pre- vention strategies. An overall decrease in fall rates over time sup- ported innovative, individualized strategies such as a colorful poster. Replication of a study exploring the patient-centered TIPS Fall assess- ment (Dykes et al., 2017) yielded similar results. Replication should continue in patient care areas out- side medical telemetry settings. REFERENCES Agency for Healthcare Research and Quality (AHRQ). (n.d.). United States health information knowledgebase. https:// ushik.ahrq.gov/dr.ui.drFunctionalGroup_ View?&system=ps&filterLetter=&results PerPage=50&sortField=100&sortDirecti on=ascending&Referer=Concepts&Syst em=ps&itemKey=169476000&Data ElementConceptID=169476000 Agency for Healthcare Research and Quality (AHRQ). (2018). Preventing falls in hospi- tals. https://www.ahrq.gov/professionals/ systems/hospital/fallpxtoolkit/index.html Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006- 3048. Choi, Y., Staley, B., Henriksen, C., Xu, D., Lipori, G., Brumback, B., & Winterstein, A.G. (2018). A dynamic risk model for inpatient falls. American Journal of Health-System Pharmacy, 75(17), 1293- 1303. https://doi.org/10.2146/ajhp1800 13 Dykes, P.C., Adelman, J., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., ... Spivack, L.B. (2019). The Fall TIPS (Tailoring Interventions for Patient Safety) pro- gram: A collaboration to end the persist- ent problem of patient falls. Nurse Leader, 17(4), 365-370. https://doi.org/ 10.1016/j.mnl.2018.11.006 Dykes, P.C., Duckworth, M., Cunningham, S., Dubois, S., Driscoll, M., Feliciano, Z., … Scanlan, M. (2017). Pilot testing fall TIPS (Tailoring Interventions for Patient Safety): A patient-centered fall preven- tion toolkit. The Joint Commission Journal on Quality and Patient Safety, 43(8), 403-413. https://doi.org/10.1016/ j.jcjq.2017.05.002 Health Research & Educational Trust. (2017). How to implement the Fall TIPS tool on …