Background: Postoperative falls are a major patient safety concern in medical-surgical units, often associated with undetected orthostatic hypotension. Early identification and prevention strategies are essential to reduce fall-related complications.

Objective: To evaluate the effectiveness of implementing orthostatic vital sign (OVS) assessment in reducing early postoperative falls in medical-surgical units.

Methods: A quantitative quasi-experimental pre–post intervention study was conducted among 750 postoperative patients in a tertiary care hospital. Participants were divided into pre-intervention (n=375) and post-intervention (n=375) groups. A standardized OVS assessment protocol was implemented prior to ambulation in the post-intervention phase. Data were collected using structured tools and analyzed using descriptive statistics, chi-square test, and logistic regression analysis.

Results: Orthostatic hypotension was identified in 38% of patients in the post-intervention group. The incidence of postoperative falls significantly decreased from 7.5% in the pre-intervention group to 1.3% in the post-intervention group (p < 0.001). Logistic regression analysis revealed that orthostatic hypotension (OR = 3.8, p < 0.001) and advanced age were significant predictors of falls. Compliance with the OVS protocol was high (96%).