Hospitals and long-term care facilities are meant to be safe. So what goes wrong when a patient or resident ends up getting injured because they fall? Shouldn’t there be zero falls?

Unfortunately, while zero falls is always the goal, it is impossible to achieve. Even when there is a clean, clutter-free environment with handrails and strong falls prevention programmes that assess, monitor and safeguard patients, some falls still occur. An unsteady inpatient may decide to get out of bed without calling for help; a senior may simply lose his or her balance while walking to a physiotherapy appointment.

In the community, one third of people 65 and older will fall at least once a year, and this increases to half for those aged 80 and older.

But while some falls cannot be prevented, in a healthcare environment it is important to monitor and to assess all falls to make sure that everything that can prevent an incident is being done.

Monitoring falls and investigating why they happen is how healthcare organisations seek to improve patient safety. Publicising results is how they can be held accountable.

This is why the BHB is including two falls figures — total falls and falls with injuries — to help you to “Know your BHB” better. This is just one of our quality and satisfaction indicators that we are sharing with the community as we move through 2016.

The BHB has three programmes: for children, inpatients and outpatients that seek to assess and to identify risk, then to support patients with appropriate safeguards and therapies.

There is also an outpatient group called the “Staying Steady Group” in the KEMH Day Hospital to help vulnerable individuals to avoid falling at home. What increases your risk of falling? Age is a significant factor. Detectable gait abnormalities increase the risk of falling, and affect 20 per cent to 40 per cent of individuals aged 65 and older and 40 per cent to 50 per cent of those aged 85 and older. Other factors that increase your risk include being unwell, injured, frail, unsteady, on medications such as antidepressants and sedatives, and having poor sight or cognitive impairments, including dementia or mental illness.

The more of those factors you have, the higher your risk of falling.

Unfortunately, people with physical frailties are more likely to fall and are more likely to be hurt. Less strength to break your fall means a higher likelihood of a head injury; seniors with more fragile bones are more likely to experience a fracture or break.

Accidents are the fifth-leading cause of death in older adults, with falls accounting for two thirds of these deaths.

Preventing falls is therefore incredibly important to patient populations. A falls prevention committee, with staff from across BHB services and locations, meets every month to assess data, to discuss contributing factors and to make possible recommendations that staff can implement. The committee also looks at how we can increase the awareness of falls prevention through educational forums.

In 2014-15, the BHB had about 40,000 Emergency and Urgent Care Centre visits, tens of thousands of outpatients in all its facilities, more than 6,000 inpatients and hundreds of residents in long-term or group-home facilities.

During that year, the BHB had 171 falls, 27 of which resulted in injury.

These injuries range from minor bruises to more severe injuries, such as a broken bone.

— For information about falls data, visit the website of the Agency for Healthcare Research and Quality, a division of the US Department of Health and Human Services. Preston Swan is the vice-president of quality and risk at the Bermuda Hospitals Board. His views are supported by the BHB’s falls prevention committee