4.1 The reduction of the incidence rate of falls using the monitoring form
The monitoring form for fall prevention was simple, clear, and feasible for points deduction. It was applied for training, assessment, and quality control of falls management in various clinical departments, combined with a nursing information system and special falls quality control process. Based on this, the important sections of the monitoring form, which did not meet the standards, would be improved further. The results showed that the incidence rate of inpatient falls decreased from 0.199‰ in 2016 to 0.101‰ in 2019, a downward trend year by year. Analysis of the annual falls incidence rate showed that the probability of falls in 2017 and 2019 was 0.84 times and 0.51 times that in 2016. It had a remarkable effect on reducing the incidence rate of falls. After using the monitoring form for fall prevention, the proportion of high risk had a downward trend, and the proportion of medium risk, low risk, and no risk had an upward trend. The possible reasons were as follows. Nurses relied on the fall scoring scale and lack of consideration of influencing factors. ②Nurses did not pay attention to the implementation of measures for patients who were not at high risk of falls. ③The patients and family members overestimated the patients’ activity, exercise ability, and poor compliance with measures to prevent falls. The results of this study indicated that nurses should not rely excessively on the fall risk assessment form in the future. They should focus more on the patients with medium and low risks and strengthen the education and guidance. The previous research results showed  that the occurrence of falls was related to the patients’ factors, disease, nurses’ professional quality, facility environment, management, and other factors. The monitoring form designed for fall prevention, integrated these influencing factors. In each round of falls quality special inspection, PDCA analysis was performed on the existing problems, which assisted the nursing managers to strengthen nursing quality management system and quality. To ensure that the core nursing system was implemented completely, work procedures, rules and regulations were improved, nurses’ advice was noted, the system and process were discussed, rectified, and revised, and clinical inspection and supervision were performed well. It raised the management level of nursing managers, modified the traditional analysis based on experience, and classified errors as personal factors.
4.2 The use of the monitoring form improves nurses' professional quality and personal ability
The research  showed that junior nurses are a high-risk group of adverse events. It may be possible that due to less experience or professional knowledge, their clinical workability, judgment, and communication skills were poor, which directly affected the quality of care and patients' safety. Therefore, nursing managers should pay more attention to the training and management of new and junior nurses. They should not only do a satisfactory job in “three basics” training but also strengthen safety awareness and establish safety beliefs. The assessment of fall risk  is the screening and evaluation of patients at high risk of falls and is the basis of safety management. It has become the basis for clinical nursing staff to take measures to prevent falls. Therefore, nursing staff should use the correct fall assessment scale for patients with high risk to improve the detection rate of those at risk of falls. When the patients’ condition changes, medication adjustments should be re-assessed, and the nursing risk assessment should be modified . Therefore, nursing managers should focus on the assessment of falls risk, strengthen the specialized theoretical knowledge of the nursing staff and strengthen the quality control of the nursing assessment. The training before the use of the assessment form, supervision during the use, and evaluation after the use can help nurses master the knowledge and nursing skills related to falls. It assists the nurses to discover high-risk factors and take practical interventions in time. In response to the problems that arise during the inspection, the nursing department, nursing safety group, and ward make plans to provide nurses with comprehensive knowledge and skills training, such as standardization of fall prevention and safety management systems, procedures, and health education. Creating a well-organized nursing safety culture atmosphere, cultivating nurses' risk awareness, prevention awareness, and legal awareness are the guarantee of reducing the occurrence of falls.
4.3 The use of the monitoring form strengthens the awareness of patients and family members participating in patient’s safety
Elderly patients are at significantly high risk for falls . The hospital in this study was conducted at a neurological and psychiatric center, where most of the inpatients were elderly. Due to the decline of physical ability, overestimating their exercising ability, and poor compliance with the implementation of fall prevention measures, the old patients decline to accept the assistance of family members or caregivers. For patients with poor compliance, nurses should adopt a customized manner to emphasize the importance and precautions of preventing falls . According to patients’ disease, cultural background, age, sex, characters, safety concepts, and the stopping elderly accidents, deaths, and injuries tool  issued by the United States Centers for Disease Control and Prevention, videos, mold materials, and micro-classes were utilized to advise patients and family members about the knowledge of falls prevention using simple words, pictures, and texts. The guidance for patients with high risk was strengthened, and the assessment results, fall risk factors, and preventive measures were informed to patients and their families in time, and they were inquired to sign for approval. Meanwhile, patients, family members, and caregivers were informed about the significance and importance of the fall warning sign, which was placed beside the patients’ beds. The patients were forbidden to turn the warning sign on without authorization. The nurses marked the bed numbers with a high risk of falls on the whiteboard in the nurse station. The doctors marked and emphasized the importance of prevention to patients and their attendants again. This mode of participation is conducive to promote attention to falls prevention and improve their cooperation. It has created a culture of “everyone participating in patient safety management” and realized the transformation from traditional mode to the new mode. Briefly, effective prevention of falls requires the participation of doctors, nurses, patients, and their families, effective communication, understanding, and cooperation. It will establish the preventive measures and ensure patient’s safety .
4.4 After the use of the monitoring form, the environmental safety management is strengthened, and the hardware facility is improved.
The variables related to falls indicate that in addition to the patients’ factors, the falls are often related to the surrounding environment and hospital equipment, such as water on the floor, no anti-slip floor tiles, night light, no armrest in the bathroom. The toilet or bathroom is a high-risk place for falls ; therefore, our hospital has improved the facilities in the toilets, added armrests, sitting toilets, anti-slip floor tiles/anti-slip mats, installed emergency buttons, placed signs when the floor is slippery, and placed anti-slip mats to reduce environmental impact. The pager is placed within easy reach for patients to guide them to familiarize themselves with the ward environment. The night light is switched on, and obstacles around the patients are removed. The height of the bed is adjusted to ensure that the patient’s feet are not suspended in air, while sitting on the edge of the bed. The nursing level is not the primary cause of falls. It requires the cooperation of related departments and multidisciplinary teams [37–39], which can reduce the incidence rate of falls and improve patients’ satisfaction.