Falls and consequent injuries in hospitalized patients: Effects of an interdisciplinary falls prevention program

Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
BMC Health Services Research (Impact Factor: 1.71). 02/2006; 6(1):69. DOI: 10.1186/1472-6963-6-69
Source: PubMed


Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time.
This study used a serial survey design to examine in-patient fall rates and consequent injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300-bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly.
A total of 34,972 hospitalized patients (mean age: 67.3, SD +/- 19.3 years; female 53.6%, mean length of stay: 11.9 +/- 13.2 days, mean nursing care time per day: 3.5 +/- 1.4 hours) were observed during the study period. Overall, a total of 3,842 falls affected 2,512 (7.2%) of the hospitalized patients. From these falls, 2,552 (66.4%) were without injuries, while 1,142 (29.7%) falls resulted in minor injuries, and 148 (3.9%) falls resulted in major injuries. The overall fall rate in the hospitals' patient population was 8.9 falls per 1,000 patient days. The fall rates fluctuated slightly from 9.1 falls in 1999 to 8.6 falls in 2003. After the implementation of the IFP, in 2001 a slight decrease to 7.8 falls per 1,000 patient days was observed (p = 0.086). The annual proportion of minor and major injuries did not decrease after the implementation of the IFP. From 1999 to 2003, patient characteristics changed in terms of slight increases (female gender, age, consumed nursing care time) or decreases (length of hospital stay), as well as the prevalence of fall risk factors increased up to 46.8% in those patients who fell.
Following the implementation of an interdisciplinary falls prevention program, neither the frequencies of falls nor consequent injuries decreased substantially. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

Download full-text


Available from: Rene Schwendimann, Jan 24, 2015
1 Follower
29 Reads
  • Source
    • "This is even more surprising given the many similarities among multidisciplinary fall prevention protocols. In an non-experimental clinical setting, Schwendimann et al., conducting an observational study to investigate the effect of an interdisciplinary falls prevention program, failed to show a substantial decrease in either frequency of falls or consequent injuries, citing low staff compliance as a probable cause [14]. While this suggests the importance of staff compliance with effective, but potentially cumbersome, multifactorial interventions, the role of staff compliance with prevention protocols has not been fully investigated in a routine clinical setting. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p = 0.039). In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.
    BMC Health Services Research 07/2012; 12(1):197. DOI:10.1186/1472-6963-12-197 · 1.71 Impact Factor
  • Source
    • "In particular, patient falls are recognized as one of the most common preventable adverse events in an inpatient setting, and was one of the top five sentinel events in 2010 (The Joint Commission, 2011). Patient falls are devastating to patients, family members , providers, and the healthcare system , with 30%Y42% of falls leading to injury (Fischer et al., 2005; Nadkarni, Iyengar, Dussa, Watwe, & Vishwanath, 2005; Schwendimann, Bü hler, De Geest, & Milisen, 2006). In addition, costs associated with fall-related injuries in U.S. hospitals are no longer reimbursable by the Center for Medicare and Medicaid Services (Kurtzman & Buerhaus, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nursing documentation is the record of care that is planned and given to patients, yet it is often missing or incomplete. A study of translating results from nurses' assessments of fall risk into tailored interventions using health information technology was used to examine nursing documentation of risk assessment, plans to manage those risks, and interventions to prevent falls. The aim of this study was to evaluate the effectiveness of an electronic fall prevention toolkit for promoting documentation of fall risk status and planned and completed fall prevention interventions. Nursing documentation related to fall risk and prevention was reviewed in 30% of randomly selected medical records for patients on the eight study units (four intervention units; 5,267 patients) and four usual care units (5,116 patients) during three separate study visits. Patients on the intervention units were more likely to have fall risk documented (89% vs. 64%, p < .0001). There were significantly more comprehensive plans of care for the patients on the interventions documented, although no differences were found related to documentation of completed interventions compared with usual care unit patient records. The documentation of fall risk status and planned interventions tailored to patient-specific areas of risk was significantly better on the intervention units that used the fall prevention toolkit as compared with usual care units. Improved documentation quality did not extend to the documentation of completed interventions.
    Nursing research 05/2012; 61(4):309-13. DOI:10.1097/NNR.0b013e31825569de · 1.36 Impact Factor
  • Source
    • "However, positive effects of these interventions are unlikely to be realized during a typical 4-day hospitalization when patients are focused on recovering from surgery or from an acute medical problem. Results from the few studies on fall prevention programmes specific for hospitals have been unsuccessful in identifying interventions to keep patients from falling (Schwendimann et al. 2006, Krauss et al. 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper is a report of the development and testing of the Self-Efficacy for Preventing Falls Nurse and Assistant scales. Patient falls and fall-related injuries are traumatic ordeals for patients, family members and providers, and carry a toll for hospitals. Self-efficacy is an important factor in determining actions persons take and levels of performance they achieve. Performance of individual caregivers is linked to the overall performance of hospitals. Scales to assess nurses and certified nursing assistants' self-efficacy to prevent patients from falling would allow for targeting resources to increase SE, resulting in improved individual performance and ultimately decreased numbers of patient falls. Four phases of instrument development were carried out to (1) generate individual items from eight focus groups (four each nurse and assistant conducted in October 2007), (2) develop prototype scales, (3) determine content validity during a second series of four nurse and assistant focus groups (January 2008) and (4) conduct item analysis, paired t-tests, Student's t-tests and internal consistency reliability to refine and confirm the scales. Data were collected during February-December, 2008. The 11-item Self-Efficacy for Preventing Falls Nurse had an alpha of 0·89 with all items in the range criterion of 0·3-0·7 for item total correlation. The 8-item Self-Efficacy for Preventing Falls Assistant had an alpha of 0·74 and all items had item total correlations in the 0·3-0·7 range. The Self-Efficacy for Preventing Falls Nurse and Self-Efficacy for Preventing Falls Assistant scales demonstrated psychometric adequacy and are recommended to measure bedside staff's self-efficacy beliefs in preventing patient falls.
    Journal of Advanced Nursing 11/2010; 67(2):438-49. DOI:10.1111/j.1365-2648.2010.05501.x · 1.74 Impact Factor
Show more