Case Analysis of Factors Contributing to Patient Falls

Falls in Patients With Communication Disability Secondary to Stroke

Patients with stroke are at high risk of falls during inpatient rehabilitation admission. Communication disability is common following stroke; however, this population is often excluded from falls research. This study aimed to examine the falls of patients with communication disability following stroke, including the circumstances, contributing factors, and outcomes of the fall. This medical record review used the Generic Reference Model of patient safety as the analytical lens and data were analyzed descriptively. The study included 109 patients who experienced 308 falls. The most common type of fall was an "unwitnessed roll from bed." Patient factors contributed to half of all falls, injuries occurred in 15% of falls, and impacts to the hospital system included additional costs and staffing. Understanding the reasons why patients are attempting to get out of bed may identify ways to reduce the risk and incidence of falls in this population.

Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis

OBJECTIVES

To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients.

METHODS

A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels.

RESULTS

Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively.

CONCLUSIONS

The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.

Prediction of Falls in Acute Care Using The Morse Fall Risk Scale

The high number of patient falls occurring within acute care hospitals throughout the United States has led to increased patient impairment and contributed to rising healthcare costs. The Morse Fall Risk Scale is a commonly used assessment tool for prediction of a patient's potential for experiencing a fall while in a healthcare facility. This retrospective study reviewed the use of the Morse Fall Risk Scale in a 300+ bed acute care hospital setting to determine adequacy for patient fall predictions over a four-month period. Use of multivariate regressions and Chi-Square test statistics revealed the Morse Fall Risk Scale was a predictor of patients' fall risk in this setting with other significant predictors of fall risk potential including male gender and diagnosis (neurologic, cardiac, general medical/surgical conditions). Patients experiencing a fall had a statistically significant longer hospital stay. Occupational therapy practitioners play an important role on the interdisciplinary team by providing a comprehensive fall assessment, developing fall prevention programs, and providing discharge recommendations.

Examining Fall Risk Assessment in Geriatric Rehabilitation Settings Using Translational Research

PURPOSE

The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada.

DESIGN

A modified version of the Stanford Biodesign Methodology was used.

METHODS

Chart reviews, a focus group (n = 8), and semistructured interviews (n = 8) were conducted to evaluate the FPS.

FINDINGS

Admission Functional Independence Measure score, age, and gender significantly correlated with risk for a fall. The tool used at this IRF was not effectively capturing patients who were at high risk for falls. All healthcare providers interviewed were knowledgeable of fall risks; however, a patient's fall risk status was rarely discussed as a team.

CONCLUSIONS

The findings informed recommendations to improve the overall FPS at this IRF.

CLINICAL RELEVANCE

Staff may require more coaching for implementing preventative measures/ensuring accountability and evaluating whether current strategies work. These insights can guide improvement initiatives at similar facilities elsewhere.

Factors influencing fall prevention for patients with spinal cord injury from the perspectives of administrators in Canadian rehabilitation hospitals

Background

Fall prevention is a priority in Canadian tertiary rehabilitation hospitals. We aimed to understand the perspectives of hospital administrators on the challenges experienced when implementing fall prevention policies/procedures for patients with spinal cord injury (SCI) in tertiary rehabilitation hospitals.

Methods

Semi-structured interviews were conducted with 10 administrators employed in six Canadian tertiary rehabilitation hospitals. Guided by an interpretive description framework, interviews were analyzed using a constant comparison approach.

Results

Challenges with fall prevention experienced by administrators fell into the three categories: 1) fall prevention policy and procedural challenges (e.g. fall prevention policy not SCI-specific, expectation of zero falls, determining contributing factors, learning from falls, and overall effectiveness of the fall prevention policy), 2) clinician-related challenges (e.g. variable staff adherence with the organizations’ fall prevention procedures, inconsistent delivery of fall prevention education, and integrating individualized fall risks to guide clinical practice), and 3) patient-related challenges (e.g. balancing risk vs independence and rehabilitation progress, responsibility for fall prevention, and non-preventable falls).

Conclusions

Fall prevention policies/procedures required by the hospitals were insufficient for clinical practice in SCI rehabilitation.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4233-8) contains supplementary material, which is available to authorized users.