Falls among Hospitalized Patients in an Acute Care Hospital: Analyses of Incident Reports

The Effect of the Stopping Elderly Accidents, Deaths, and Injuries Program on Falls Prevention in Neurosurgical Patients

ABSTRACT

BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect ( P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program's effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients' outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.

Consequences of Inpatient Falls in Acute Care-A Retrospective Register Study

AIMS

The objectives of this study were (1) to explore the consequences of falls; (2) to find out time and place of the fall events; and (3) to explore the impact of falls on the length of hospital stays in adults' inpatient acute care.

BACKGROUND

In hospitals, falls are the most common accidents that can occur to a patient during hospitalization. Injuries resulting from serious falls can cause lifelong harm to the patient due to loss of well-being and independence.

DESIGN

A retrospective, cross-sectional, register study based on the data from electronic patient records was conducted.

METHODS

The data included 114,951 inpatients, of which 743 had fallen. Data was collected between January 2014 and December 2016.

RESULTS

One-third of falls caused injury. Most injuries were to the head area, and the most common injuries were pain or confusion. The falls usually occurred at the beginning of the treatment in the patient's room or on the way to the toilet. Falls in the hospital increased the length of stay.

CONCLUSIONS

A large proportion of falls occur at the beginning of treatment, so it is important to start fall prevention measures as soon as the patient arrives at the hospital.

A 10-Year Study of the Trend of Accidental Falls in the Elderly in a Japanese Hospital

Elderly people are prone to falls. We established the Falls Prevention Working Group (FPWG) at our hospital in 2015 to reduce the number of falls during hospitalization. This study compared the trend of in-hospital falls in the elderly in two time periods (2008/9 and 2018/9) and determined the effects of FPWG-implemented measures. Using medical records, we counted the monthly number of falls suffered by patients during hospitalization in April 2008-March 2009 and April 2018-March 2019. We also categorized the falls according to the severity of fall-related complications.A total of 3609 hospital falls were recorded during the 2008-2019 period (2008/9: n = 433, 2018/9: n = 324). Falls were more common in patients aged 70-79 in 2008/9 but were noted in those aged ≥ 80 in 2018/9. The mean number of falls/month (27.3 ± 6.4, range: 12-45) was stable throughout the year. The incidence of falls in 2018/9 (1.90/1000 per persons per day) was significantly lower than in 2008/9 (2.30/1000, p = 0.006). Level ≥ 3b accidents, reflecting serious accidents with complications, were encountered in 12 of 433 accidents in 2008/9 compared with significantly fewer accidents (2 of the same severity among 324 accidents) in 2018/9 (p = 0.030).Our results showed a decrease in in-hospital falls in 2018/9 and that the sufferers were older relative to 10 years earlier. A multidisciplinary team should recommend measures to prevent falls and an environment "resilient" to falls, and encourage patients to be aware of possible falls.

Clinical Nurse Specialists Using Evidence-Based Practice to Prevent Falls

PURPOSE/OBJECTIVES

The purpose of this quality improvement project was to reduce inpatient falls and falls with injury by implementing the Hester Davis Fall Program, a comprehensive, evidence-based prevention program, with the leadership of clinical nurse specialists.

DESCRIPTION OF THE PROJECT/PROGRAM

The Plan-Do-Study-Act model was utilized to implement the program at 2 adult acute care facilities. Clinical nurse specialists collaborated with nurse managers to guide planning, implementation, and evaluation of patient outcomes. Routine meetings with Hester Davis sustainability coaches and access to data analytic dashboards provided visibility of audit data, allowing for the intentional selection of targeted strategies to improve risk assessment scoring and implementation of appropriate interventions.

OUTCOME

Although both facilities demonstrated overall favorable trends in fall rates, one facility demonstrated rates less than the National Database of Nursing Quality Indicators mean. In the 9 months following implementation, total falls for both facilities decreased from 744 to 692 for the same period in the previous year, resulting in estimated cost-savings of $202 176 to $491 400.

CONCLUSION

Clinical nurse specialists play a key role in the successful implementation of evidence-based programs. As organizations look to improve quality measures, it is vital that senior nurse leaders ensure the availability of appropriate resources including the identification of individuals with the appropriate skill set to lead quality improvement.

Validation of the stratify scale for the prediction of falls among hospitalized adults in a tertiary hospital in Colombia: a retrospective cohort study

The STRATIFY scale has been implemented as a preventive strategy for predicting the risk of accidental falls among hospitalized adults. However, there is still uncertainty about its accuracy. This study aimed to perform an external validation of the STRATIFY fall prediction scale in hospitalized adults in one tertiary care hospital in Bogotá, Colombia. The study was a retrospective cohort of adult hospitalized patients in a high-level complexity care hospital. The sample selected included admitted patients (age ≥ 18), consecutively by the institution between 2018 and 2020, with an evaluation of the fall risk measured by the STRATIFY score given to each at the time of hospital admission. For assessing the scale's feasibility, its discriminative capability was obtained by calculating sensitivity, specificity, likelihood ratios, predictive values, and area under the ROC curve. The evaluation included 93,347 patient hospital records (mean 56.9 years, 50.2% women). The overall sensitivity score was 0.672 [IC 95% 0.612-0.723], the specificity score was 0.612 [IC 95% 0.605-0.615], and the positive likelihood ratio was 1.73 [IC 95% 1.589-1.891]. The area under the ROC curve was 0.69 [IC 95% 0.66-0.72]. Subgroups of age obtained similar results. Applying the STRATIFY scale at hospital admission resulted in a lower performance of the tool-predict falls in hospitalized patients. It is necessary to implement an individual evaluation of the risk factors for falls in order to structure appropriate care plans to prevent and improve hospital safety.

Associations of intrinsic capacity, fall risk and frailty in old inpatients

Introduction

This study explored the associations of intrinsic capacity (IC), fall risk, and frailty in geriatric inpatients.

Methods

A total of 703 hospitalized patients aged 75 years or older were recruited for this retrospective observational study from Zhejiang Hospital using a comprehensive geriatric assessment. The IC composite score was constructed from the scores of the Chinese version of the Mini-Mental State Examination, Short Physical Performance Battery, Short Form Mini Nutritional Assessment, 15-item Geriatric Depression Scale, and self-reported hearing and vision impairment. Adverse outcomes were recorded as the fall risk and frailty using the Morse Fall Scale and the Clinical Frailty Scale. Spearman's correlation coefficient analyses and multivariate logistic regression models were used to explore the associations between IC, high fall risk, and frailty.

Results

Declined IC composite scores were associated with increased risks of falls [odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.57-0.72] and frailty (OR = 0.45, 95%CI: 0.37-0.54) among older hospitalized patients after adjusting for the related potential confounders. In addition, decreased cognitive, vitality, locomotion, and psychological scores were associated with increased adverse health conditions, with ORs ranging from 0.26 to 0.70. Vision impairment was observed to increase the risk of frailty (OR = 0.42, 95%CI: 0.23-0.76) after adjusting for the related potential confounders.

Discussion

This study indicated that declined IC was associated with fall risk and frailty in older inpatients. Further prospective studies are needed to explore the longitudinal associations between baseline IC and subsequent risk of falls and frailty.

Observational Prospective Study to Determine the Efficacy of 'Non-Slip Socks' vs. 'Adequate Footwear' Regarding the Number of Falls Observed among Admitted Patients

BACKGROUND

Fall prevention is an important indicator of the quality of patient care. Prevention includes the use of adequate footwear. Our objective is to determine the differences in the number of falls between patients with "adequate footwear" and "non slip socks", and their associated consequences, to support their use in the prevention of falls among hospitalized patients.

METHODS

This is an observational prospective study on inpatient falls. Patient characteristics, fall circumstances, and injuries were collected through Clinical Report Forms, a review of fall reports, and medical records. Admitted patients over 18 years old were recruited from Geriatric and Internal Medicine Units over a brief period of 3 months.

RESULTS

A total of 158 hospitalized patients were recruited. In total, 77 patients (48.73%) were assigned to the non-slip socks group, and 81 (51.27%) were assigned to the adequate footwear group. There were 21 falls during the study period, all of which were experienced by the adequate footwear group (p < 0.0001). The mean age of the patients who fell was 83.14 (range 60-100) years old. The most frequent reasons for admission among the patients who fell were COVID-19 infection (19%) and oncological complications (19%). Overall, 61.9% of patients had a high risk of falling. Most falls (76.1%) occurred in patient rooms, and most of these occurred while wandering around. The most frequent reason for falls was slipping (14/21). For 16 of 21 patients, falls did not have immediate consequences, while 5 had contusions and 1 suffered a wound. Nobody needed to be admitted to the ER or suffered external hemorrhages or loss of consciousness.

CONCLUSIONS

Non-slip socks represent an adequate alternative to well-fitting rubber-soled footwear. It seems that non-slip socks could prevent falls among hospitalized patients; nevertheless, further studies are necessary to clarify their role in preventing hospital falls and reducing injury rates.

Falls in oldest-old adults hospitalized in acute geriatric ward

PURPOSE

The study aims to identify risk factors for falling among acutely ill older patients, hospitalized in acute geriatric ward.

METHODS

A retrospective study of 260 cases of patients who had fallen and 439 controls was conducted in a geriatric ward. We retrieved from the electronic hospital records data including patient demographics, medical diagnoses, and laboratory results, and drugs taken prior to the fall were reviewed. In addition, data on functional and cognitive status were recorded. Admission Morse Falls Scale for every patient was also retrieved.

RESULTS

The following on-admission diagnoses were associated with a higher incidence of falls during hospitalization: hypertension (84% vs. 38%), congestive heart failure (CHF), 74% vs 16%, dementia (36% vs. 5%), and delirium (36% vs 5%). A higher percentage of fallers compared to controls consumed beta blockers (69% vs. 53%), benzodiazepines (46% vs. 32%), antidepressants (33% vs. 23%), oral diabetes drugs (20% vs. 11%) and opiates (8% vs. 4%). On-admission Morse Falls Scale score was found to be higher in the patients who fell (59 vs.53). The strongest predictors of falling during hospitalization were CHF, hypertension, dementia, delirium, assisted mobility and dependence.

CONCLUSION

A systematic screening of risk factors for falls and identification of them might contribute to reducing the risk associated with falls during hospitalization.

Allogeneic haematopoietic stem cell transplantation and patient falls: impact of lower extremity muscle strength

OBJECTIVES

Patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) have a higher risk of falls than those receiving other therapies for haematological disorders. This study aimed to investigate the impact of pretransplant lower extremity muscle strength (LEMS) on post-transplant falls.

METHODS

In this retrospective cohort study, patients aged ≥18 years who underwent allo-HSCT were included. All data were extracted from medical records. LEMS was defined as the knee extension force measured by a handheld dynamometer divided by the patient's weight. The receiver operating characteristic (ROC) curve was used to calculate the optimal LEMS cut-off value for prediction of falls. Patients were categorised into low and normal LEMS groups based on the cut-off value. The impact of pretransplant LEMS on post-transplant falls was analysed using a Cox proportional hazards model.

RESULTS

In total, 101 patients were analysed. During the observation period, falls occurred in 32 patients (31.7%). The ROC curve analysis results showed that the optimal LEMS cut-off value for prediction of falls was 45.4% per body weight. In multivariate analysis, pretransplant low LEMS was a significant predictor of falls in model 1 with patient characteristics as a confounding factor and model 2 with medications-inducing falls as a confounding factor, respectively (model 1: HR 3.23, 95% CI 1.37 to 7.64; model 2: HR 2.82, 95% CI 1.20 to 6.59).

CONCLUSIONS

Pretransplant LEMS was a significant predictor of post-transplant falls. The results of this study may help to prevent falls in patients undergoing allo-HSCT.

Interventions to reduce falls in hospitals: a systematic review and meta-analysis

BACKGROUND

Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

Hospitalised adults.

INTERVENTION

Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches.

OUTCOME MEASURES

Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR).

RESULTS

There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias.

CONCLUSION

Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.

Anticholinergic Drug Use on Admission and the Risk of In-Hospital Falls in Older Hospitalized Patients

Purpose

In-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls.

Patients and Methods

This retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium.

Results

A total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional anticholinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06–2.10). Other measures, ie anticholinergic drug use (yes/no) and different categories of anticholinergic drug burden, measured with the ARS, ACB and list of Chew, were all not associated with in-hospital falls.

Conclusion

Anticholinergic drug exposure on admission is possibly not a main risk factor for in-hospital falls among older patients.

Effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care setting

AIM

To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care hospital setting in Singapore.

METHOD

A retrospective before-and-after study design was adopted.

RESULTS

Our results revealed that the use of bed exit alarms are associated with a reduction in falls incidence.

CONCLUSION

Bed exit alarm systems are associated with reduced fall incidence. Nonetheless, for an institution to benefit from the technology, there will be a need to take into account the effects of "alarm fatigue", ability of nurses to respond in time to alarms, and selection of right alarm mode/limits based on the patient's profile.

Prevalence and characteristics of incident falls related to nocturnal toileting in hospitalized patients

Objectives: Although nocturia is a risk factor for incident falls in the community, studies are required to gain an understanding of incident falls related to nocturnal toileting in hospitals. The aim of this study is to describe the prevalence and characteristics of incident falls in adult hospitalized patients related to nocturnal toileting.Methods: A retrospective review of the electronic incident reporting and learning system and medical records of inpatients that had an incident fall.Results: The prevalence of toileting-related incident falls was 53% (73/137) and 28% of all incident falls were related to nocturnal toileting.Intravenous fluid infusion was associated with falls related to toileting, whereby median perfusion volume during night-time was 375 ml [IQR: 225-578 ml].Conclusions: The prevalence of nocturnal toileting-related incident falls in hospitals is high. Nocturia could be a leading cause of these incident falls. Intravenous fluid infusion might be part of the aetiology of (iatrogenic) nocturia.