Falls and fall injuries in hospitals are the most frequently reported adverse event among adults in the inpatient setting. Advancing measurement and improvement around falls prevention in the hospital is important as falls are a nurse sensitive measure and nurses play a key role in this component of patient care. A framework for applying the concepts of high reliability organizations to falls prevention programs is described, including discussion of the core characteristics of such a model and determining the impact at the patient, unit, and organizational level. This article showcases the components of a patient safety culture and the integration of these components with fall prevention, the role of nurses, and high reliability.