Patterns and Predictors of Inpatient Falls and Fall-Related Injuries in a Large Academic Hospital (original) (raw)
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einstein (São Paulo), 2019
Objective: To investigate the use of fall-risk-increasing drugs among patients with falls reported to the Patient Safety Office of a hospital, and to identify the factors associated with high risk for fall. Methods: A cross-sectional study, carried out in a teaching hospital. The study population was the universe of fall reports received by the Patient Safety Office. The dependent variable was a high risk for falls. The Medication Fall Risk Score was used to measure fall risk. Descriptive, univariate and multivariate analyses were performed. Results: Of the 125 fall reports in the study, 38 (30.4%) were in 2014, 26 (20.8%) in 2015, and 61 (48.8%) in 2016. Half of the patients (63; 50.4%) were classified as high fall risk and 74 (59.2%) had two or more risk factors for the event. The most frequently used drug classes were opioids (25%), anxiolytics (19.7%), beta-blockers (9.9%), angiotensin II antagonists (7%) and vascular-selective calcium channel blockers (7%). After the adjusted analysis, the factors associated with falls were amputation (odds ratio: 14.17), female sex (odds ratio: 2.98) and severe pain (odds ratio: 5.47). Conclusion: Medications are an important contributor to in-hospital falls, and the Medication Fall Risk Score can help identify patients at a high risk for falls.
Characteristics and circumstances of falls in a hospital setting
Journal of General Internal Medicine, 2004
OBJECTIVE: To describe the epidemiology of hospital inpatient falls, including characteristics of patients who fall, circumstances of falls, and fall-related injuries. DESIGN: Prospective descriptive study of inpatient falls. Data on patient characteristics, fall circumstances, and injury were collected through interviews with patients and/or nurses and review of adverse event reports and medical records. Fall rates and nurse staffing levels were compared by service. SETTING: A 1,300-bed urban academic hospital over 13 weeks. PATIENTS: All inpatient falls reported for medicine, cardiology, neurology, orthopedics, surgery, oncology, and women and infants services during the study period were included. Falls in the psychiatry service and falls during physical therapy sessions were excluded. MEASUREMENTS AND MAIN RESULTS: A total of 183 patients fell during the study period. The average age of patients who fell was 63.4 years (range 17 to 96). Many falls were unassisted (79%) and occurred in the patient’s room (85%), during the evening/overnight (59%), and during ambulation (19%). Half of the falls (50%) were elimination related, which was more common in patients over 65 years old (83% vs 48%; P CONCLUSIONS: Falls in the hospital affect young as well as older patients, are often unassisted, and involve elimination-related activities. Further studies are necessary to prevent hospital falls and reduce fall injury rates.
Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study
2019
Background: Patient falls are considered a challenge to the patient's safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even the death of the patient. This study aims to investigate the associations between risk factors among fallers in comparison with the control group. Methods: A prospective nested case control study was performed on 185 patients who fell and 1141 controls were matched with the patients at risk of fall in the same ward and during the same time. This study was conducted in a university educational hospital in Tehran with 800 beds during a 9-month period. The data included demographics, comorbidities, admission details, types of medication, clinical conditions, and activities before or during the fall. The data was collected from clinical records, hospital information system, error reporting system and observations, and the interviews with the fallers, their families and care givers (physicians, nurses, etc). Data analysis was conducted through time-based matching using a multi-level analysis. Results: In a multilevel model including patient-related, medication, and care-related variables, the factors that were significantly associated with an increased risk of patient falls included: longer length of stay (odds ratio [OR] = 1.01; CI = 0.32 to 0.73), using chemotherapy drugs, sedatives, anticonvulsants, benzodiazepines, and angiotensin-converting enzyme (ACE) inhibitors, visual acuity (OR = 6.93; CI = 4.22 to 11.38), balance condition (OR = 6.41; CI = 4.51 to 9.11), manual transfer aid (OR = 8.47; CI = 5.65 to 12.69), urinary incontinence (OR = 8.47, CI = 5.65 to 12.69), and cancer (OR = 2.86, CI = 1.84-4.44). These factors were found to be associating with more odds for a falling accident among patients. Several characteristics such as fall history (OR = 0.48; CI = 1.003 to 1.02), poly-pharmacy (OR = 1.37, CI = 00.85 to 2.2), stroke (OR = 0.94, CI = 0.44 to 2.02), and nurse to patient ratio (incidence rate ratio = 1.01, CI = 0.01 to 0.03) were not significantly associated with falling in hospitals. Conclusion: It seems that a combination of both patient-related factors and history of medication should be considered. Moreover, modifiable clinical characteristics of patients such as vision improvement, provision of manual transfer aid, diabetes control, regular toilet program, and drug modification should be considered during the formulation of interventions. Implications for policy makers • We identify contributory factors affecting fall incidents with the aim of meeting hospital managers' needs for timely and relevant intervention to improve patient safety in healthcare systems. • These findings are applicable in all hospitals. Implications for the public The results of the present study reveal factors affecting fall incidents, can be helpful in identifying high risk patients, can encourage the advocacy and the involvement of patients in devising strategies to eliminate such barriers, and can finally help prevent the occurrence of falls, especially in elderly patients.
Risk factors for fall occurrence in hospitalized adult patients: a case-control study
Revista latino-americana de enfermagem, 2018
to identify risk factors for falls in hospitalized adult patients. a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0. risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01]. risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and...
Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system
Infection Control and Hospital Epidemiology, 2007
Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system." Infection JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Journal of Patient Safety, 2008
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.
Falls Among Adult Patients Hospitalized in the United States: Prevalence and Trends
Journal of patient safety, 2012
OBJECTIVES: The purpose of this study was to provide normative data on fall prevalence in U.S. hospitals by unit type and to determine the 27-month secular trend in falls before the implementation of the Centers for Medicare and Medicaid Service (CMS) rule, which does not reimburse hospitals for care related to injury resulting from hospital falls. METHODS: We used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006, and September 30, 2008, to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical, and surgical nursing units. More than 88 million patient days (pd) of observation were contributed from 6100 medical, surgical, and medical-surgical nursing units in 1263 hospitals across the United States. RESULTS: A total of 315,817 falls occurred (rate = 3.56 falls/1000 pd) during the study period, of which, 82,332 (26.1%) resulted in an injury (rate = 0.93/1000 pd). Both total fall and injurious fal...
Factors associated with the risk of falls in hospitalized adult patients
Revista da Escola de Enfermagem da USP
OBJECTIVE Analyzing factors related to the risk of falls in hospitalized adult patients. METHOD A cross-sectional, analytical and quantitative study, developed in Clinical and Surgical Hospitalization Units from June to August 2015. Data collection instruments were sociodemographic and clinical forms, and the Morse Scale. Data were obtained with the patients and from medical records. Absolute and relative frequencies were used in the univariate statistical analysis, and chi-square test in the bivariate analysis. RESULTS 612 patients participated in the study. An association (p<0.001) was found between the high risk of falls and clinical neurological hospitalization, surgical trauma (hospitalization) and comorbidities such as diabetes mellitus, systemic arterial hypertension, visual impairment, vertigo and fear of falling. CONCLUSION An association between the risk of falls was found due to hospitalization, comorbidities and intrinsic factors. Regarding extrinsic factors, an assoc...
Factors Associated With Severity of Falls In Adult Hospital Patients: A Retrospective Audit
2021
Background: Injurious falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with injurious hospital falls. It is important to continuously analyse the factors associated with the severity of falls which can inform the implementation of any fall preventive strategies. This study aims to identify risk factors associated with the severity of falls in hospitalised adult patients in Western Australia.Methods: This study involved a retrospective analysis of hospital inpatient falls records extracted from the hospital’s Clinical Incident Database. Falls clinical incidents were reviewed and analysed from May 2014 to April 2019.Results: There were 3705 complete reported cases of falls with the average age of the patients was 68.5±17.0 years, with 40.2% identified as female. Gender, activity at time of fall and height of f...
A retrospective cohort study of factors associated with severity of falls in hospital patients
Scientific Reports
Severity of falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with severity of falls in hospital. It is important to continuously analyse the factors associated with severity of fall which can inform the implementation of any fall preventive strategies. This study aims to identify factors associated with the severity of falls in hospitalised adult patients in Western Australia. This study involved a retrospective cohort analysis of inpatient falls records extracted from the hospital’s Clinical Incident Database from May 2014 to April 2019. Severity of falls were classified as three Severity Assessment Code (SAC): SAC 1 was “high” causing serious harm or death; SAC 2 was “medium” causing moderate or minor harm; and SAC 3 was “low” indicating no harm. Univariable and multivariable generalised ordinal logistic r...