Problem and Purpose: A community-focused hospital has experienced increased falls and fall injuries within its two adult Medical/Surgical units. The hospital’s quality improvement team set a fiscal year (FY) 24 goal of a 3% reduction of falls and injuries from FY23. The fall rate target was 3.7, and the fall with injury rate was 1 for FY24. The first unit’s fall and fall injury rates were at 8.9 and 2.5, and the second unit’s were 4.6 and 1.7. Increased fall and fall injury rates contribute to prolonged hospital stays and higher mortality. The purpose of the quality improvement project was to decrease falls and injuries among adult patients on two medical- surgical units by implementing a nurse-driven tele-sitter algorithm for high fall-risk patients with a Morse Fall Risk Score > 60. Methods: The nursing staff documented the Morse Fall Score on admission, each shift, and upon transfer. The new process included a nurse-driven tele-sitter algorithm for a Morse Fall Risk Score > 60 who attempted unsafe ambulation. The nursing staff initiated the tele-sitter algorithm and documented the intervention in the Patient Safety Flowsheet. Data collection included weekly audits of the tele-sitter algorithm adherence and monthly fall and injury rate data from the quality and safety dashboard. Results: The median adherence rate to the tele-sitter algorithm was 100% over fifteen weeks, despite variability in the early weeks. The first unit’s fall rate decreased from 8.9 to 4.7, and the injury rate decreased from 2.5 to 0.5. The second unit’s fall rate decreased from 4.6 to 3.4, and the injury rate decreased from 1.7 to 0. Both units had a 3% reduction in falls and injuries from FY23 and met their fiscal year targets. Conclusions: The implementation of an evidence-based nurse-driven tele-sitter algorithm for high fall-risk patients reduced fall and injury rates while promoting patient safety. Keywords: fall prevention, falls, injury, tele-sitter, video monitoring