Inpatient Fall Research Articles

Tailored Prevention of Inpatient Falls

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units.

Tailored Prevention of Inpatient Falls

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units.

Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies

The objective of this study was to compare fall rates in older hospital inpatients with and without cognitive impairment. Relationships between age, gender, mobility, cognitive impairment, care dependency, urinary incontinence and medical disciplines were investigated. Falls are common in older people with cognitive impairment, but studies in the hospital setting are rare. A secondary analysis of three nationwide prevalence studies in German hospitals from the years 2005, 2006 and 2007 was conducted. Trained staff nurses used a standardised instrument to collect data about accidental falls within the last two weeks in their institutions and about other patient characteristics. Data from 9246 patients aged 65 years or older from 37 hospitals were analysed. The fall rate for cognitively impaired patients was 12·9%, while only 4·2% of older persons without cognitive impairment experienced a fall. Comparison between medical disciplines showed great differences concerning fall risk for confused and non-confused inpatients. In multivariate logistic regression analysis, the odds-ratio association of cognitive impairment and falls was 2·1 (CI 1·7-2·7). Higher age (OR 1·5, CI 1·2-1·9), greater care dependency (OR 1·6, CI 1·1-2·1), reduced mobility (OR 2·6, CI 1·9-3·7) and being a patient on a geriatric ward (OR 1·8, CI 1·1-2·9) were also statistically significant predictors in this model. Cognitively impaired older people constitute a high-risk group for accidental falls in hospitals. Fall prevention strategies in the hospital setting should address cognitively impaired inpatients as an important high-risk group.

Technology and Building Design: Initiatives to Reduce Inpatient Falls among the Elderly

This paper offers a narrative exploration of interventions for inpatient falls among the elderly with respect to the design of technology (equipment and furniture) and buildings. Most of the contributory risk factors for inpatient falls among the elderly were identified in the 1950s, but incident and injury rates remain relatively unchanged in the 2000s. Interventions have predominantly focused on staff and organizational changes, for example monitoring (observation) and communication, possibly in response to increased patient privacy (isolation) in single rooms. The clinical response has been to modify the patient by means of medication review, continence management, and impact protectors. This paper considers whether technology and building design have helped or hindered the newly admitted frail and/or confused elderly patient at risk of falling, assuming the provision of good nursing and medical practice (e.g., observation, treatment, and care).

Reducing the Patient Fall Rate in a Rural Health System

In healthcare facilities, patient falls have been a major contributing factor associated with patient injuries that result in increased costs and increased length of stay. Recent actions by the Department of Health and Human Services, enacted through the Department of Medicare and Medicaid Services, now hold healthcare facilities financially responsible for injury to patients that result from falls (CMS Hospital Acquired Conditions). Because of these rulings, costs associated with patient falls are now a greater threat to the survival of rural healthcare facilities. The rate of patient falls at Wise Regional Health System was unacceptably high. As a result of statistically analyzing the demographics of previous fall victims, and initiating additional interventions for identified patients, Wise Regional Health System has been successful in drastically decreasing their inpatient fall rate.

Predictors of serious injury among hospitalized patients evaluated for falls

Inpatient falls are common and result in significant patient morbidity. To identify predictors of serious injury being found on imaging studies of inpatients evaluated after a fall. Retrospective study. : An 1171-bed urban academic medical center. All inpatients who fell on thirteen medical and surgical units from January 1 to December 31, 2006. Patient characteristics, circumstances surrounding falls, fall-related injuries, and length of stay were collected through review of incident reports and computerized medical records. Primary outcome of fall-related injury was determined by evidence of injury on imaging studies within two weeks of the fall. Univariate and multivariate logistic regression were used to calculate adjusted odds ratios (ORs) for injury after an inpatient fall. A total of 513 patients had 636 falls during the study time period. Fall incidence rate was 1.97 falls per 1,000 patient days. 95 patients (19%) fell multiple times (range, 2-6 events); 74% of the falls occurred in patients who were previously assessed as being "at risk" by the nursing staff. Multivariate analysis, adjusting for age and sex, found evidence of trauma after a fall (OR = 24.6, P < 0.001) and ambulatory status (OR = 7.3, P < 0.01) to be independent predictors of injury being found on imaging studies. Inpatient falls are common despite high-risk patients being identified. After adjusting for age and sex, evidence of trauma and ambulatory status were independent predictors of an injury being found on imaging studies after an inpatient fall.

Bridging the gap between research and practice: review of a targeted hospital inpatient fall prevention programme

Objective:Falls among older inpatients are frequent and have negative consequences. In this study, the effectiveness of a fall prevention programme in reducing falls and fall injuries in an acute hospital...

Evaluating the Relationship Between Inattention and Impulsivity-Related Falls in Hospitalized Older Adults

Impulsivity in older adults is poorly understood and there is limited literature on the relationship between impulsivity and falls. This retrospective study evaluated the relationship between of inattention and impulsivity related falls (IRF) in hospitalized older adults. The sample (N = 192) included patients 65 years and older with a documented in-patient fall in 2007. "Impaired judgment" was identified as the critical attribute of IRF. The Confusion Assessment Method item for inattention was extracted as the variable for inattention. Twenty-eight percent (28%) of falls were classified as IRF. A significant relationship was found between inattention on the shift prior to a fall and the fall being an IRF (Chi-square = 45.5, df = 1, p = .00, Phi = .54, p = .00). Early identification of older adults with impaired attention has potential to reduce IRF when nursing uses this assessment to implement additional safety interventions for hospitalized older adults.

Are Call Light Use and Response Time Correlated With Inpatient Falls and Inpatient Dissatisfaction?

Inpatients use call lights to seek nurses' assistance. Although implied in patient safety, no studies have analyzed data related to the use of or response time to call lights collected by existing tracking mechanisms monitoring nursing practice. This study used archived hospital data to determine the correlation of the call light use rate and the average call light response time with the fall rate, injurious fall rate, and patient satisfaction scores in acute inpatient care settings.

Falls in older adult psychiatric inpatients

Falls are the commonest cause of trauma in older adults and are of particular concern in hospital settings (Ojo et al., 2009). Osteoporotic fractures occurring as a consequence of falls are a leading cause of morbidity and mortality in this population (Stubbs et al., 2009). Older adult psychiatric long-stay patients are at elevated risk of osteoporosis, with one recent study confirming this link by demonstrating that over half had osteoporosis (58%) with just under one-third having ostetopenia (32%) (Stubbs et al., 2009). The incidence of falls is known to be higher in psychiatric settings, and this is particularly so in older adult settings (Blair and Gruman, 2006). Risk factors predisposing older adult psychiatric patients to falls include chronic illness, high rates of cognitive disturbance, psychotropic medication use and behavioral manifestations, and in particular agitation and wandering, two factors which are both strongly associated with falls (Blair and Gruman, 2006). Clearly, older adult psychiatric patients are at an elevated risk of falls (Blair and Gruman, 2006). Even if a patient has not fallen prior to hospitalization, the mere presence of being admitted immediately increases their subsequent falls risk (Blair and Gruman, 2006).

Postoperative Patient Falls on an Orthopedic Inpatient Unit

We are not aware of any data looking specifically at inpatient falls in an orthopedic ward. We reviewed all postoperative orthopedic patients who fell during 2003 and 2005 on a single postoperative orthopedic unit. Seventy patients (1%) fell, resulting in 2.5 falls per 1000 musculoskeletal inpatient days. Most (n = 45, 64%) were bathroom related, were unassisted (n = 54, 77%), and occurred during the evening or night shift (n = 46, 66%). Thirteen (19%) patients acquired an injury as a consequence. Female sex (odds ratio [OR] = 1.9), patient age greater than 65 years (OR = 1.7), prolonged admission (OR = 1.7), and admission for primary or revision knee arthroplasty (OR = 5.0) were all significant risk factors for a postoperative inpatient fall. This information has provided us with some insight to direct the development of a fall prevention program specific to postoperative orthopedic patients.

Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports

Introduction:Falls in hospital inpatients are common, with reported rates ranging from 3 to 14 per 1000 bed days. They cause physical and psychological harm, are associated with impaired rehabilitation, increased...

Frequencies of falls in Swiss hospitals: Concordance between nurses’ estimates and fall incident reports

Background Patient falls are frequent incidents in hospitals, and various measurement methods are described in the literature to assess in-patient fall rates. However, the literature includes no validation of nurses’ estimates of fall frequencies, which are the preferred assessment method in multi-centre surveys. Objectives To explore the concordance of nurses’ estimated fall frequencies with continuously collected data. Design Cross-sectional, correlational secondary data analysis. Sample/Setting Patient fall data from 21 wards in 2 Swiss acute care hospitals participating in the RICH Nursing Study. Methods Registered nurses’ ( N = 233) estimated fall frequencies, assessed by the International Hospital Outcome Study questionnaire in absolute number of falls over the last month, and, using a four-point Likert scale (never = 1; frequently = 4), over the last year, were compared to standardized hospital fall incident reports compiled over the same periods. Fall incident reports for the last month were assessed in absolute numbers and were calculated as fall rates per 1000 patient days, with data computed at the ward level. The concordance with nurses’ estimates was then tested using Spearman’s rho and Kendall’s tau correlations. Results The mean last-year fall frequencies estimated by nurses on the four-point Likert scale ranged from 1.4 to 3.1 for non-injurious falls and from 1.0 to 2.6 for injurious falls per ward. The fall rates assessed using fall incident reports over the same period ranged from 0.1 to 3.8 non-injurious falls per 1000 patient days and from 0.1 to 2.6 injurious falls per ward. Nurses’ estimates and fall incident reports correlated significantly regarding the last year, both for injurious falls ( r = 0.685, p = 0.014) and non-injurious falls ( r = 0.630, p = 0.028), although no statistically significant correlations were found regarding the 1 month estimates. Conclusions Nurses’ long-term estimates of patient incidents are concordant with continuously and systematically assessed data, and offer valid data where other measurement methods are unavailable.

Characteristics of Hospital Inpatient Falls across Clinical Departments

Background: Hospital inpatient falls are common and may lead to injuries and prolonged hospitalization. Although hospital studies have reported overall fall rates and injuries associated with falls, few have addressed population characteristics and circumstances of falls across clinical departments within a hospital setting. Objective: To determine inpatient fall rates in an urban public hospital and to explore associated characteristics across clinical departments. Methods: The study was conducted in a 300-bed urban public hospital in Switzerland from 1999 to 2003. Patient data and data from the hospital’s standardized fall reporting system on hospital inpatients’ first falls, along with associated characteristics, across the departments of internal medicine, geriatrics and surgery, were analyzed. Descriptive statistics and statistical tests: χ² and ANOVA tests with multiple comparisons tests (post-hoc analysis) were used. Results: Over this 5-year period, 34,972 patients were hospitalized (female 53.6%; mean age 67.3 ± 19.3 years; mean length of stay 11.9 ± 13.2 days) including 2,512 patients (7.5%) who experienced at least one fall during their hospitalization (geriatrics 24.8%; internal medicine 8.8%; surgery 1.9%). The fall rates per 1,000 patient (adjusted for age) days differed significantly between all of the departments (geriatrics 10.7; internal medicine 9.6; surgery: 3.2) (p < 0.001). Overall, 30.1% of the patients who fell experienced minor injuries and 5.1% major injuries. In geriatrics, fall-related circumstances such as transferring were more common (40.4%) than in medicine (33%) or surgery (30.4%) (p < 0.001), whereas falling out of bed was rarer (16.4%) (surgery 27.1%; internal medicine 20.5%) (p < 0.001). In addition, the prevalence of risk factors among patients who fell varied significantly among clinical departments, except for impaired cognition and narcotic use. Conclusion: In the hospital studied, inpatient falls are significantly more common in departments of geriatrics and internal medicine than in surgical departments. Fall rates, related injuries and circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics. When monitoring falls, hospitals should therefore consider differences in characteristics associated with patient falls across clinical departments. High priorities should be allocated in view of identifying patients at risk of falling and implementing fall prevention strategies and interventions.

Height of Hospital Beds and Inpatient Falls

Height of Hospital Beds and Inpatient Falls

A Case-Control Study to Assess the Impact of Anemia and Other Risk Factors for In-hospital Falls

Objective: To assess the association of in-hospital falls with anemia status before the fall, concurrent diseases, and drug use in adult inpatients. Methods: This was a retrospective case-control study of patients hospitalized between January 1, 1998 and June 30, 2003. To be included as a case, patients had to experience an in-hospital fall, be hospitalized for more than 24 hours, and have a hemoglobin test 14 days or less before the fall. Control patients were matched 1:1 on age, sex, race, hospital service, and year of admission. The relationship between anemia status, comorbidities, drug use, and in-hospital falls was evaluated using multivariate logistic regression. Results: There were 1126 fall cases that met study criteria, and matching controls were identified and included in the regression analysis. Cases were more likely to be anemic (75% versus 70%; P = 0.01), have a longer mean length of stay (13 versus 8 days; P < 0.001), and diagnosed with 2 or more comorbidities (41% versus 30%; P < 0.001). More cases received at least 1 drug group of interest before the fall (79% versus 49%; P < 0.001). Comorbidities that increased the likelihood of experiencing an in-hospital fall were dementia (odds ratio [OR], 1.9), chronic kidney disease (OR, 1.6), gastrointestinal disease (OR, 1.4), and diabetes (OR, 1.2). Anemia did not increase the likelihood of an in-hospital fall. Drugs associated with in-hospital falls were anticonvulsants (OR, 2.4), antidepressants (OR, 2.2), benzodiazepines (OR, 1.9), antiarrhythmics (OR, 1.6), and antipsychotics (OR, 1.5). Conclusions: Several common comorbidities increased the risk of experiencing an in-hospital fall; however, anemia was not among them. Central nervous sytem-acting drugs such as anticonvulsants, antidepressants, and benzodiazepines placed patients at highest risk for an in-hospital fall.

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

BackgroundPatient 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.MethodsThis 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.ResultsA 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.ConclusionFollowing 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.

Incidence and Risk Factors for Inpatient Falls in an Academic Acute-care Hospital

The aims of this study were to assess the frequency of inpatient falls and to evaluate potential risk factors in an academic hospital. An electronic audit of the inpatient database at the Tama-Nagayama Hospital of Nippon Medical School from April 2004 through March 2005 was performed. Inpatient falls were registered regularly with incident reports submitted by nurses and other hospital employees discovering the fall. All inpatients were analyzed for potential risk factors using univariate and multivariate logistic regression analysis. Of the 8,537 patients, 109 (1.3%) fell. Multivariate logistic regression analysis showed that inpatient falls were significantly associated with a patient age of 51 to 70 years (odds ratio, 2.4; 95% CI, 1.3 - 4.7) or of 71 to 90 years (odds ratio, 4.2; 95% CI, 2.4 - 8.1); with a hospital stay of 15 to 21 days (odds ratio, 3.4; 95% CI, 1.6 - 7.0), 22 to 28 days (odds ratio, 4.3; 95% CI, 1.8 - 9.5), or 29 days or longer (odds ratio, 13.8; 95% CI, 8.3 - 24.1); with admission to the surgery (odds ratio, 2.0; 95% CI, 1.1 - 3.5), orthopedics (odds ratio, 2.5; 95% CI, 1.1 - 4.9), neurosurgery (odds ratio, 3.0; 95% CI, 1.5 - 5.9), or urology service (odds ratio, 3.9; 95% CI, 1.8 - 8.2); and with no surgical procedure (odds ratio, 1.6; 95% CI, 1.0 - 2.6). The present study demonstrates that patient-related factors, such as age and length of stay, and treatment-related factors, such as no surgical procedure and admission to the surgery, orthopedics, neurosurgery, or urology service, are independent risk factors for inpatient falls. The results suggest that fall-prevention programs should target patients with these risk factors.

The Timed Up and Go Test does not predict length of stay on an acute geriatric ward

This study aimed to determine whether the admission Timed Up and Go Test (TUG) predicted the length of stay of patients in an acute geriatric ward. Consecutive patients were quasi-randomly allocated to either a model development sample or a model validation sample. Multivariate Cox proportional hazards regression was used to model length of stay. Variables considered for inclusion in the development model were risk factors for length of stay reported in the literature and univariate predictors from our dataset (p < 0.05). Variables selected for use in the development sample were then tested in the validation sample. Of 2463 patients of mean age 82.1 years, 932 (37.8%) were able to complete the TUG. Despite a significant, though weak, relationship between the length of stay and the TUG time (Spearman coefficient 0.18, p < 0.001), no time clearly identified patients with longer length of stay. Patients unable to complete the TUG had a median length of stay of 11 days (IQR 7 to 18), 40% longer than those able to complete the TUG (median 8 days, IQR 8 to 12, p < 0.001). Other significant (p < 0.05) predictors of length of stay in both samples were number of active medical diagnoses, referral from the emergency department, in-patient fall, and diagnosis of ulcer or infection. The admission TUG time should not be used to screen for patients likely to have longer lengths of stay. The value of the TUG lies in determining the patient's ability to complete it, rather than the time taken.

Are patient falls in the hospital associated with lunar cycles? A retrospective observational study

BackgroundFalls and associated negative outcomes in hospitalized patients are of significant concerns. The etiology of hospital inpatient falls is multifactorial, including both intrinsic and extrinsic factors. Anecdotes from clinical practice exist in which health care professionals express the idea that the number of patient falls increases during times of full moon. The aim of this study was to examine in-hospital patient fall rates and their associations with days of the week, months, seasons and lunar cycles.Methods3,842 fall incident reports of adult in-patients who fell while hospitalized in a 300-bed urban public hospital in Zurich, Switzerland were included. Adjusted fall rates per 1'000 patient days were compared with days of the week, months, and 62 complete lunar cycles from 1999 to 2003.ResultsThe fall rate per 1000 patient days fluctuated slightly over the entire observation time, ranging from 8.4 falls to 9.7 falls per month (P = 0.757), and from 8.3 falls on Mondays to 9.3 falls on Saturdays (P = 0.587). The fall rate per 1000 patient days within the lunar days ranged from 7.2 falls on lunar day 17 to 10.6 falls on lunar day 20 (P = 0.575).ConclusionThe inpatient fall rates in this hospital were neither associated with days of the week, months, or seasons nor with lunar cycles such as full moon or new moon. Preventive strategies should be focused on patients' modifiable fall risk factors and the provision of organizational conditions which support a safe hospital environment.