Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital.
ABSTRACT 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.
- SourceAvailable from: Merav ben natan[Show abstract] [Hide abstract]
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
- [Show abstract] [Hide abstract]
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
- [Show abstract] [Hide abstract]
ABSTRACT: ACCESSIBLE SUMMARY: • The literature review was intended to form an understanding of the patient safety concept and its intension in psychiatric inpatient care and its constitutive factors from the perspective of organization management, staff and patients. • Organization safety culture is present in all aspects of patient safety and within it organization management has a major role in creating good working conditions and environment for the staff. Staff produces its individual output, which is influenced by management, while the patient's role is more that of an informant according to the existing literature. In future, there will definitely be a need to emphasize the patient's role in developing patient safety practices and organization safety culture. • It is important to develop inpatient care by paying attention to the diversity of the patient safety concept as different aspects are so closely connected. Lack of attention in one area may affect others, leading to errors and adverse events in care. The diversity of the concept should be noted in research, education, and when making patient safety plans in organizations. ABSTRACT: Patient safety is widely discussed, but little has been written from the perspective of psychiatric inpatient care, nor on which factors create its patient safety. This paper seeks to understand the concept of patient safety and its intension in psychiatric inpatient care, and to identify factors in organization management, staff and patients' roles which constitute patient safety in such units. A literature search was conducted, and the articles selected were analysed by identifying factors defined to be connected to patient safety and classifying them according to their connection to organization management, staff and patient roles. According to the literature, organization safety culture is present in all aspects of patient safety. Organization management has the main role in patient safety within the organization culture, for example, through leadership, safety practices and creating good working conditions and environment for the staff. Staff's role is influenced by management, but has more individual input in different areas, while the patient's role is more that of an informant so that care can be planned according to the patient's preferences. When developing patient safety it is important to remember the diversity of the concept so that all areas are considered in the developmental work.Journal of Psychiatric and Mental Health Nursing 07/2012; 20(6). DOI:10.1111/j.1365-2850.2012.01949.x · 0.98 Impact Factor