A Biopsychosocial Approach to Analyzing Inpatient Falls

Abstract

Purpose: While research exists identifying factors that contribute to inpatient falls, patients in hospitals continue to fall. We suggest this is influenced by a lack of consistency in the implementation and documentation of evidence-based fall precautions, and that existing fall screens and protocols do not consistently identify potential fallers or prevent falls. This study examines biopsychosocial factors not commonly investigated that may affect falls. We analyzed patient mobility level, polypharmacy, mental status, language spoken, insurance type, and substance use on fall incidence and fall precaution protocol implementation in an urban, academic health care system. Materials/Methods: Using the incident reporting system, postfall huddles and electronic medical records, a comprehensive aggregate database was created of 217 inpatient fall incidents and 100 randomized nonincidents. Variables included insurance type, primary spoken language, history of substance use, mental status, polypharmacy, mobility level, and whether the fall precaution protocol was implemented. Chi-square tests, z tests of proportions, and absolute risk reduction (ARR) and increase (ARI) were calculated to assess associated fall potential for each predictor. Results: 55.2% of patients screened to be at risk for falls did not have a fall precaution protocol in place when they fell. The predictor with the largest effect (ARI 30%) on fall incidence was whether the fall precaution protocol was missing. Patients requiring Supervision through Minimal Assist for mobility were associated with an ARI of 18%; nonintact mental status (ARI 20%) and history of substance use (ARI 10%) were also associated with fall incidences. Having a history of substance use or having Medicaid insurance each reduced fall precaution protocol implementation by 15%. Conclusions: Novel results suggest that patients requiring less assistance for mobility experienced higher incidences of falls, and patients with a history of substance use and Medicaid insurance had a higher risk for not having fall precaution protocols implemented. Patients would benefit if physical therapists and nurses shared mobility assessment tools and communication methods, potentially improving mobilization triaging between the professions.