Serious fall injuries in hospitalized patients with and without cancer

Clinical characteristics and influencing factors of serious fall injuries among older inpatients: A secondary analysis of multicenter cross-sectional administrative data

BACKGROUND

Inpatient falls are common adverse events in hospitals, particularly among older adults. However, current research on falls in the older population is limited by small sample sizes and reliance on single-center designs without distinguishing the different levels of fall injuries.

OBJECTIVE

To examine the circumstances of falls in older inpatients and investigate the factors influencing serious fall injuries.

DESIGN

A secondary analysis of multicenter cross-sectional administrative data from the China National Database of Nursing Quality (CNDNQ).

SETTING(S)

67 hospitals in Hunan, China.

PARTICIPANTS

5143 fall incidents from 5048 older inpatients were included from January 2019 to December 2022.

METHODS

Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe fall characteristics. Given the multilevel data structure, a Generalized Linear Mixed Model (GLMM) with a Logistic link function was employed, treating hospitals and wards as random effects. Univariate and multivariate analyses were conducted.

RESULTS

The prevalences of fall-related injuries and serious fall injuries in this study were 63.3 % and 25.0 %, respectively. Nurse-to-patient ratio at the time of fall ≤0.05 (aOR = 1.522, 95 % CI: 1.297-1.785), female gender (aOR = 1.304, 95 % CI: 1.137-1.497), a lengthy hospital stay (aOR = 1.009, 95 % CI: 1.001-1.018) were associated with an increased risk of serious fall injuries. Surgical (aOR = 0.655, 95 % CI: 0.482-0.889) and orthopedic wards (aOR = 0.649, 95 % CI: 0.449-0.939) exhibited lower risks of serious fall injuries than internal medicine wards. The period from 8:00 to 15:59 was associated with a higher risk of serious fall injuries compared to the period from 0:00 to 7:59 (aOR = 1.416, 95 % CI: 1.171-1.713). Compared to lying, standing (aOR = 2.594, 95 % CI: 1.733-3.883), getting in/out of bed (aOR = 1.403, 95 % CI: 1.009-1.951), walking or rehabilitating (aOR = 3.039, 95 % CI: 2.194-4.208), toileting (aOR = 1.411, 95 % CI: 1.038-1.917), and showering (aOR = 2.170, 95 % CI: 1.391-3.385) were associated with an increased risk of serious fall injuries.

CONCLUSIONS

Fall-related injuries and serious fall injuries are highly prevalent among older inpatients. The study provides insights for targeted fall prevention strategies, improving nursing management and patient safety.

REGISTRATION

Not registered.

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit

PURPOSE

Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit.

METHODS

A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients.

RESULTS

There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01).

CONCLUSION

The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.

Risk Factors for Fall-Related Serious Injury among Korean Adults: A Cross-Sectional Retrospective Analysis

The purpose of this study was to identify the risk factors of serious fall-related injuries by analyzing the differences between two fall groups: one with serious fall-related injuries and one without such injuries. Applying a retrospective, descriptive investigation study design, we analyzed the degree of fall-related injury and the risk factors related to serious falls by conducting a complete survey of the medical records of fall patients reported throughout one full year, 2017, at a tertiary hospital in Seoul, Korea. Among the patients with reported falls, 188 sustained no injury (63.1%), 72 sustained minor injury (24.2%), and 38 patients sustained serious injury (12.8%). The serious fall-related injuries included eight lacerations requiring suture (2.7%), 23 fractures (7.7%), five brain injuries (1.7%), and two deaths (0.7%). Analysis results indicated that taking anticoagulants/antiplatelet drugs (p = 0.016) and having a fall history (p = 0.038) were statistically significant in the differences between the group with serious injury related to falls and the group without serious injury. Logistic regression revealed that taking anticoagulant/antiplatelet drugs was the factor most significantly correlated with serious injuries related to falls (OR = 2.299, p = 0.022). Results show that it is necessary to develop a patient-tailored fall prevention activity program.

The effectiveness of a participatory program on fall prevention in oncology patients

Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study, 68 participants were recruited at a medical centre in Taiwan. A 20-min fall prevention program was given to patients. A questionnaire was used to evaluate the effectiveness of program after on day 3 of intervention. The data of fall incidence rates were collected from hospital record. Fall incidences with and without the program were used to compare the effectiveness of intervention. The patients' knowledge and self-efficacy of fall prevention are better than after intervention. A statistically significant difference in fall incidence rate was observed with (0.0%) and without (19.3%) the program. Our findings suggest that the fact of the bedside is that the most risk for falling in hospital must be communicated to the hospitalized patients. Educating patients about fall prevention and activities associated with falling increases their awareness of the potential of falling and promoting patient safety.

Fall prevention in high-risk patients

In the oncology population, disease process and treatment factors place patients at risk for falls. Fall bundles provide a framework for developing comprehensive fall programs in oncology. Small sample size of interventional studies and focus on ambulatory and geriatric populations limit the applicability of results. Additional research is needed.