As in other medical environments, fall prevention is critical in a rehabilitation setting. It is foundational to ensuring safety, good outcomes and success as patients relearn how to move and regain full function of their bodies after a serious health event.
A single fall has immediate negative effects on the following:
- Family confidence in the healthcare provider and facility
- Facility reputation
- Patient satisfaction and well-being
- Quality-based reporting
- Regulatory compliance and accreditation
Because rehabilitation presents inherent fall risks, prevention efforts must be intentional.
“Fall prevention isn’t about limiting mobility, but enabling safe progress,” said JoAnna Sheahin, associate administrator, director of Nursing at Adventist HealthCare Rehabilitation. “When done well, fall safety protects patients, supports therapy goals, preserves momentum, builds confidence and improves outcomes.”
The First Step in Fall Prevention
At Adventist HealthCare Rehabilitation, fall prevention starts before a patient walks through our doors. During the preadmission process, a clinical liaison evaluates the patient to determine baseline mobility status. The liaison then enters this data into an electronic admission history tool, allowing rehabilitation experts to be aware of a patient’s fall risk before admission.
Fall prevention efforts continue upon admission with the following steps:
- Review: A specially trained mobility technician reviews the data documented by the clinical liaison.
- Preparation: The mobility technician ensures mobility equipment is on hand and in place for the patient.
- Comprehensive evaluation: The mobility technician performs a comprehensive mobility and fall-risk assessment.
- Education: The mobility technician and admission nurse partner to orient the patient to the rehabilitation environment, teaching them how to use the bed and armchairs, call for assistance and perform other necessary tasks.
“Our team uses standardized criteria to determine when a patient is safe to mobilize independently, with or without devices,” Sheahin said. “Until that threshold is met, we adhere to clear safety standards.”
These standards require a staff member to remain at arm’s reach during patient toileting, and all transfers and ambulation away from the bed must make use of a gait belt. Upon discharge, patients receive extensive education on navigating stairs, using assistive devices and organizing their homes to maximize mobility and minimize fall risk. According to Sheahin, this layered, proactive approach “ensures patients are supported safely while still progressing aggressively toward functional independence.”
Reduced Risk Through Continuous Visual Monitoring
In November 2017, Adventist HealthCare Rehabilitation advanced our fall-prevention efforts through continuous visual monitoring (CVM). This allows for real-time, 24-hour observation of patients at greatest risk of falls or other significant hospital-based injuries. Appropriate candidates for CVM experience one or more of the following:
- Cognitive impairment caused by delirium, dementia, a brain injury or a central nervous system disorder
- Confusion and/or disorientation
- Impaired mobility and/or use of an assistive ambulatory device due to fall risk
- History of falls
- Marianjoy Fall Risk score of four or greater
- Movement disorder, such as spasticity, ataxia or dyskinesia
- Sensory impairment
- Sleep disturbance
- Suicidal ideation (patient must be directable)
CVM also helps improve care by monitoring staff adherence to best practices of purposeful hourly rounding, turn-and-reposition protocols for patients at risk for pressure injuries, and more – all while saving money and reducing staffing needs. Artificial intelligence (AI) enhances CVM by recognizing how patients move within their environment and identifying risk patterns, which allow staff to intervene proactively.
“We’re moving beyond traditional standards toward a data-driven, prevention-focused model of rehabilitation care,” Sheahin said. “Rather than relying solely on reactive observation, we’re leveraging CVM and AI to further differentiate our services and protect patient safety.”
Striving Toward Continuous Improvement
Since implementing CVM, Adventist HealthCare Rehabilitation has made tremendous strides in fall prevention, improving to a superb 92.78 percentile rank in 2025, ranking our facility in the top 10% nationwide. Fall rates during that time have decreased from 3.51% to 2.68% of all patients admitted. These efforts have led to recognition within the local community and beyond. In 2024, Adventist HealthCare Rehabilitation was deemed one of America’s Best Physical Rehabilitation Centers by Newsweek.
Encouraging as these achievements are, the staff is eager to continue reducing fall risk and protecting patient safety and health. When falls occur, AHR staff meet to analyze what led up to a fall and what improvements should be made. The meetings, led by the charge nurse, involve all members of a patient's care team. The outcomes of these meetings are documented in the adverse event reporting system and reviewed daily. Process management meetings ensure timely follow-up and accountability.
At the end of the month, the CVM team performs a comprehensive review of any falls that occur. The aim is to identify the following:
- Appropriate adjustments to processes and interventions to reduce fall risk
- Contributing factors that led to falls
- Trends in patient falls
“Fall prevention at Adventist HealthCare Rehabilitation is a proactive, multidisciplinary process,” Sheahin said. “Our strong culture of transparency, accountability and continuous improvement produces excellent, measurable results, demonstrating our commitment to patient safety and functional recovery.”
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