Patient Falls in the Acute Care Setting

Janken, Janice K.; Reynolds, Betty Ann; Swiech, Kristy

doi:10.1097/00006199-198607000-00007

Cited by 70 publications

(39 citation statements)

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“…Having bed rails raised had a negative association with falling. Many of our findings regarding patient-related risk factors for falling are confirmatory of prior studies, such as gait or balance deficit or lower extremity problems, 12,17,18,21,22 confusion, 10,12,17,18,21,22 and urinary or stool frequency or incontinence. 12,17 The use of sedatives/hypnotics has been documented as a risk factor for falling in the hospital in another study 10 and as a risk factor for injurious falls in the nursing home.…”

Section: Discussionsupporting

confidence: 86%

A case-control study of patient, medication, and care-related risk factors for inpatient falls

et al. 2005

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OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/ or nurses and review of adverse event reports, medical records, and nurse staffing records.SETTING: Large urban academic hospital.PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall. MEASUREMENTS AND MAIN RESULTS:In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of ''up with assistance'' compared with ''bathroom privileges'' (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling. Due to the risk of significant injury and the increased cost, reduction of falls in hospitals is a major priority for hospital quality and patient safety. While falls have been relatively well studied in community and nursing home settings, less is known about the prevention of hospital falls. Previous research has identified risk factors for falling in the hospital, including impaired balance or gait, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, urinary frequency, nocturia, incontinence, specific diagnoses, and use of certain medications, such as benzodiazepines, antipsychotics, and sedatives. 10,[12][13][14][15][16][17][18] Yet comparative studies on hospital falls have been limited in several ways, including variations in study design, setting, patient population, and definitions of risk factors. Some studies have continued to focus solely on the elderly or relied only on data included in hospital incident reports or chart review. Furthermore, environmental and care-related factors, including patient-to-nurse ratio, are often overlooked as potential risk factors for falling in these studies. Because fall prevention programs should be linked to the etiologic factors of fa...

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Section: Discussionsupporting

confidence: 86%

A case-control study of patient, medication, and care-related risk factors for inpatient falls

et al. 2005

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“…Patients with a history of falls have previously been noted to be more likely to fall whilst in hospi tal [10,11], 'Needing help to toilet/incontinence/diarrhoea' also reflects cognitive state and mobility and, therefore, overlaps with some other risk factors. All of these have pre viously been seen to be associated with falling [8,9,12].…”

Section: Resultsmentioning

confidence: 99%

“…There has been much interest in risk factors for fall ing and consequent intervention to reduce the incidence of falling [2], It was recently shown that with multifactorial intervention the risk of falling in community-living elderly can be reduced [3], Similar studies in institutional or in-pa tient settings have also found risk factors sig nificantly associated with falling. Most of these have been studies on long-stay elderly care wards [4][5][6][7] or acute medical (all ages) wards [8,9],…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Risk Factors for In-Patient Falls in Acute and Rehabilitation Elderly Care Wards

1996

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Falls occurring in elderly in-patients during periods of hospitalization are common, and attempts have been made to predict and prevent them based on risk factor analysis. These have not looked extensively at specific elderly care wards. We have investigated in-patient falls in mixed acute and rehabilitation elderly care wards in a case-controlled study. Fifty fallers were paired with fifty non-fallers, and their risk factors for falling evaluated. Only three risk factors were significantly more common in the fallers. These were: a previous history of falls; the presence of confusion/disorientation, and needing help to toilet/incontinence/diarrhoea. Prediction of falls based on the presence of the first two of these risk factors gives a sensitivity of 68% and a specificity of 88%. A risk factor approach to the prediction of falls in an in-patient elderly care setting seems to be less practical than was previously hoped.

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“…18,19 Previous data suggested that there are multiple clinical and functional risks for hospitalized patient falls, including age, 6,7 previous history of falls 10 or stroke, 11 active neoplasm, stroke, lower postural hypotension, the use of a walking aid and psychoactive drugs, 22 cardiac failure and digoxin, 22 opioids and anti-inflammatory drugs, 24 dementia, disorientation, and low abbreviated mental status scores, as well as lower extremity weakness, 6,7,24 and incontinence, sleepiness, and general weakness. 21 There is already substantial literature showing that screening patients with risk assessment tools provides no clear benefit, and other interventions also have shown no clear benefit. 28,29 This prospective study provides an original contribution to the growing literature of falls in hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Injury Associated With Falls in Elderly Hospitalized Patients in a Community Hospital

Chelly¹,

Conroy²,

Miller³

et al. 2008

Journal of Patient Safety

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Objective: Hospitalized patient falls are a major cause of disability, functional impairment, and even death. The objective of this prospective study was to assess the frequency and contributing factors of falls in hospitalized patients. Methods: Between December 2004 and November 2005, data related to falls in hospitalized patients were recorded: patient demographics, the patient's functionality, mental status, surrounding circumstances, and the level of injury. Outcome measures were overall rates of patient falls as a function of ward, shift, month, age, and incidence rate ratios (IRRs). Results: Falls were recorded in 611 patients. The overall patient fall rate was 4.36 (95% confidence interval, 4.02 to 4.72) per 1000 patient-days. The fall rate was significantly above the mean for the neurosurgical (IRR = 2.32; P G 0.001) and short-stay wards (IRR = 1.69; P = 0.013). Patients aged 56 to 70 years or older than 70 years fell 1.45 and 1.78 times more frequently, respectively, versus patients aged 55 years or younger (P G 0.001). The odds that a fall resulted in injury were multiplied by 1.19 for each additional decade of age (P = 0.018), and the age-adjusted injury rate for the oncology ward (46.4%) was significantly higher than the overall average (P = 0.001). Conclusions: Age and the patient condition before and during hospitalization resulted as the most important determinants of falls in hospitalized patients.

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Patient Falls in the Acute Care Setting

Cited by 70 publications

References 0 publications

A case-control study of patient, medication, and care-related risk factors for inpatient falls

A case-control study of patient, medication, and care-related risk factors for inpatient falls

An Evaluation of Risk Factors for In-Patient Falls in Acute and Rehabilitation Elderly Care Wards

Risk Factors and Injury Associated With Falls in Elderly Hospitalized Patients in a Community Hospital

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