Background
Patient fall is among the top five sentinel events in hospitals due to the resultant functional loss and injury sustained. Precise fall risk assessment and prevention strategies are important components of a fall prevention program. Due to psychiatric conditions and medications, these patients may require a different fall management program compared to other patient populations.

Objective
The objective of this review was to identify the best available evidence for the effectiveness of nursing fall risk assessment tools, interventions to reduce incidence of falls, and common risk factors of adult psychiatric patients who fall.

Inclusion Criteria
Types of participants
Adults (19 to 64 years) diagnosed with mental illness

Types of interventions
Evaluation of nursing fall risk assessment tools in adult psychiatric settings, and interventions, which minimised fall risk or fall rates.

Types of outcome measures
Number of patient falls during hospitalisation was the main outcome.

Types of studies
Primary quantitative studies published in English language.

Search Strategy
The literature search sought published studies, and was limited to English language reports. There were no date restrictions applied to the search. Electronic databases searched included:

CINAHL
PubMed
Cochrane Central Register of Controlled Trials
PsycINFO
ScienceDirect
Scopus
Web of Science
Wiley-InterScience
ProQuest
MedNar

Methodological quality
Studies retrieved were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI).

Data Extraction
Data including specific details about the methods, settings, purposes, populations, interventions, and outcomes significant to the review’s objectives were extracted by two independent reviewers using standardised data extraction tools from JBI-SUMARI.

Results
Eleven studies were included in this review: three before-and-after studies, four descriptive studies, two case control studies and two cohort studies. Evidence with regards to the effectiveness of fall risk assessment tools and prevention strategies was inconclusive. Certain risk factors which were more frequently associated with falls included diagnoses of depression, bipolar disorder, and dementia / Alzheimer’s disease, altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, polypharmacy, and taking of certain medications such as sedatives, antidepressants and mood stabilisers, particularly lithium.

Conclusion
Evidence on the effectiveness of fall risk assessment tools and prevention strategies in psychiatric setting was inconclusive due to a paucity of studies. However, certain risk factors were found to be more commonly associated with falls in adult psychiatric patients (Level III Evidence).