Patterns and Predictors of Inpatient Falls and Fall‐Related Injuries in a Large Academic Hospital •

Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 11/2005; 26(10):822-7. DOI: 10.1086/502500
Source: PubMed


Most research on hospital falls has focused on predictors of falling, whereas less is known about predictors of serious fall-related injury. Our objectives were to characterize inpatients who fall and to determine predictors of serious fall-related injury.
We performed a retrospective observational study of 1,082 patients who fell (1,235 falls) during January 2001 to June 2002 at an urban academic hospital. Multivariate analysis of potential risk factors for serious fall-related injury (vs no or minor injury) included in the hospital's adverse event reporting database was conducted with logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CI95)
The median age of patients who fell was 62 years (interquartile range, 49-77 years), 50% were women, and 20% were confused. The hospital fall rate was 3.1 falls per 1,000 patient-days, which varied by service from 0.86 (women and infants) to 6.36 (oncology). Some (6.1%) of the falls resulted in serious injury, ranging by service from 3.1% (women and infants) to 10.9% (psychiatry). The most common serious fall-related injuries were bleeding or laceration (53.6%), fracture or dislocation (15.9%), and hematoma or contusion (13%). Patients 75 years or older (aOR, 3.2; CI95, 1.3-8.1) and those on the geriatric psychiatry floor (aOR, 2.8; CI95, 1.3-6.0) were more likely to sustain serious fall-related injuries.
There is considerable variation in fall rates and fall-related injury percentages by service. More detailed studies should be conducted by floor or service to identify predictors of serious fall-related injury so that targeted interventions can be developed to reduce them.

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    • "Falls are usually defined as a sudden unexpected change in position from a standing, sitting, or horizontal position . This includes slipping from a chair to the floor, finding a patient lying or sitting on the floor, and assisted falls (Fischer et al., 2005). Several definitions emphasize that the change in position is unintentional, and is not caused by sudden paralysis, an epileptic seizure, or a strong blow (Feder, Cryer, Donovan, & Carter, 2000). "
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    ABSTRACT: PurposeTo identify risk factors for elder falls in a geriatric rehabilitation center in Israel.DesignRetrospective chart review study.Methods Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not.FindingsOf elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition.Conclusions The research findings single out patients who are allegedly at a lower risk of falls than more complex patients.Clinical RelevanceCaregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular.
    07/2014; DOI:10.1002/rnj.170
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    • "Intrinsic risk factors are integral to the patient system and may be associated with age-related changes, including previous falls, reduced vision, unsteady gait, musculoskeletal system deficits, mental status deficits, acute illness, and chronic illness. Extrinsic risk factors are external to the patient system and related to the physical environment, including medication, lack of support equipment by bathtubs and toilets, design of furnishings, condition of floors, poor illumination, inappropriate footwear, improper use of devices, and inadequate assistive devices [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]. In addition, it had been found that the primary root causes of fatal falls as reported by health care organizations involved inadequate staff communication, incomplete orientation and training, incomplete patient assessment and reassessment, environmental issues, incomplete care planning , unavailable or delayed care provision, and an inadequate organizational culture of safety [14] [15]. "
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    ABSTRACT: Background: Patient falls in hospitals are common and affect approximately 2% to 17% of patients during their hospital stay. Patient falls are a nursingsensitive quality indicator in the delivery of inpatient services. Objective: To assess the effect of educational training program on nurses’ knowledge and performance regarding prevention of fall at one of the health insurance organization hospitals in Alexandria. Setting: The study was conducted at 284 bed general hospital affiliated with the Health Insurance Organization in Alexandria. Design: A quasi-experimental design was followed. Participants: The study sample included all nurses of different ranks working at four departments namely, orthopedic, medical, surgical, ICU unit. Results: There was a significant difference regarding all factors under study before and after the educational programme except for two individual factors, old age (p = 0.84), overall poor health status (p = 0.38), and two health factors, uses aids (p = 0.50), treatment by heparin (p = 1.00), and two environmental factors, poor lighting (p = 0.34), loose cords or wires (p = 0.30) and bells (p = 0.30), and one miscellaneous factor, patient education (p = 0.85) and tidy environment(p = 0.85). All departments showed posttest performance improvement, the total performance median for departments regarding environmental factor (p = 0.04) and health education (p = 0.001). Conclusion: Education programmes should be regularly, updated in view of changing knowledge and work practices.
    Open Journal of Nursing 12/2012; 2:358-364. DOI:10.4236/ojn.2012.24053
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    • "Our initial fall rate at the beginning of the study period was lower than other studies in urban, acute-care hospitals, though in line with the lower end of the reported spectrum, typically between 2.2 falls per 1000 patient days to 6.3 falls per 1000 patient days [20-22]. While the interventions put in place in 2006 were effective, aiding the further decrease was that the assessment rate of newly admitted patients was nearly 100% in 2010. "
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    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
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