Use of routinely collected data in reporting falls in hospitals in a local health district in New South Wales, Australia

Prioritising patients for hospital occupational therapy to reduce inpatient falls: A retrospective case-control study to identify predictive patient falls risk factors

Introduction

Prompt identification of patients susceptible to falls is required by occupational therapists to initiate early falls prevention and management strategies. This study identified the intrinsic and extrinsic risk factors of patients who experience early inpatient falls (within 48 hours of admission).

Method

A retrospective case-control study was completed at a tertiary hospital. Data were extracted from medical records. Adults aged 18 years and older, admitted with any diagnosis, to any ward within the hospital between July 2019 and June 2020 were included. Cases were identified as those who fell within 48 hours of admission and controls did not experience a fall.

Results

The study sample included 218 patients (109 cases and 109 control patients). Most falls occurred in the patient's room (n = 54) or bathroom (n = 47), as a result of slipping (n = 50) or while patients were toileting (n = 32). Multivariate regression analysis identified significant predictors of inpatient falls, including unassisted mobilisation (odds ratio (OR) 5.25), impaired balance (OR 7.25), reduced muscle strength (OR 5.25) and impulsivity (OR 19.57). Receiving occupational therapy reduced risk of falling by 81%.

Conclusion

Falls risk factors that are predictive of early inpatient falls should be identified at admission and used to prioritise patients for occupational therapy.

Documenting fall episodes: a scoping review

Documentation is an important measure for the management of fall risk because it concentrates the attention of professionals, raises awareness of the existence of fall risk factors, and promotes action to eliminate or minimize them. This study aimed to map the evidence on information to document episodes of falls in older adults. We opted for a scoping review, which followed the Joanna Briggs Institute protocol for this kind of study. The research question that guided the research strategy was "What recommendations emerge from the research on the documentation of falls of the older person?" The inclusion criteria defined were older adults who had at least one fall; nursing documentation after a fall has occurred; and nursing homes, hospitals, community, and long-term care. The search was performed on the following platforms: MEDLINE, CINAHL, Scopus, and Cochrane Database of Systematic Reviews in January 2022 and allowed the identification of 854 articles, which after analysis resulted in a final sample of six articles. The documentation of fall episodes should answer the following questions: Who? What? When? Where? How? Doing what? What was said? What were the consequences? and What has been done? Despite the recommendations for the documentation of fall episodes as a preventive measure for their recurrence, there are no studies evaluating the cost-effectiveness of this measure. Future studies should explore the association between fall documentation, fall recurrence prevention programs, and their impact on the prevalence rate of the second and subsequent falls, as well as the severity of injuries and fear of falling.

Validation of nursing documentation regarding in-hospital falls: a cohort study

BACKGROUND

In-hospital fall incidents are common and sensitive to nursing care. It is therefore important to have easy access to valid patient data to evaluate and follow-up nursing care. The aim of the study was to validate the nursing documentation, using a specific term in the registered nurses´ (RNs´) discharge note, regarding inpatient falls according to the outcome of a digitalized data extraction tool and the discharge note itself.

METHODS

At a teaching hospital, 31,571 episodes of care were eligible for inclusion in this retrospective cohort study. A stratified sampling including five groups was used, two with random sampling and three with total sampling. In total, 1232 episodes of care were reviewed in the electronic patient record using a study-specific protocol. Descriptive statistics were used.

RESULTS

In total, 590 episodes of care in the study cohort included 714 falls. When adjusted for the stratified sampling the cumulative incidence for the study population was 1.9%. The positive predictive value in total for the data extraction tool regarding the presence of any fall, in comparison with the record review, was 87.4%. Discrepancies found were, for example, that the RNs, at discharge, stated that the patient had fallen but no documented evidence of that could be detected during admission. It could also be the opposite, that the RNs correctly had documented that no fall had occurred, but the data extraction tool made an incorrect selection. When the latter had been withdrawn, the positive predictive value was 91.5%. Information about minor injuries due to the fall was less accurate. In the group where RNs had stated that the patient had fallen without injury, minor injuries had actually occurred in 28.3% of the episodes of care.

CONCLUSIONS

The use of a specific term regarding fall in the RNs´ discharge note seems to be a valid and reliable data measurement and can be used continuously to evaluate and follow-up nursing care.