Challenges in Defining Inpatient Falls in the NDNQI
Inpatient falls data have been collected in the National Database of Nursing Quality Indicators (NDNQI) since 2003. Different types of care units have contributed data since that time, including adult critical care, step-down, medical, surgical, and medical-surgical. In 2012, a team from the University of Kansas revised and expanded the NDNQI fall indicator with two main goals in mind, to include a wider variety of nursing-unit types and to include additional categories of falls.
Adding new types of nursing units and categories of falls to the NDNQI raised several challenges. For example, adding falls data from psychiatric and pediatric units raised the issue of how to categorize intentional falls. Both psychiatric patients and children may intentionally throw themselves on the floor, but the existing NDNQI fall definition did not include this type of fall. Pediatric and neonatal patients pose other issues. Children may fall while learning to walk and run and infants or children may experience a type of fall called a baby-drop. None of these circumstances fit into the existing NDNQI fall indicator.
After considering several approaches, the investigators added only one new cause-based fall category, falls “attributable to one or more intrinsic, physiologic factors.” Physiologic factors would include hypotension, dysrhythmia, seizure, transient ischemic attach, and stroke. Other physical conditions could also contribute physiologic factors related to falls, such as medication or delirium. Documenting the causes of falls was deemed less important than accurate recording of falls and consequences for patients. The investigators also believed that, while it is important to collect data, collecting numerous categories of falls might reduce clinicians’ time spent on patient care.
Staggs VS, Davidson J, Dunton N, Corsser B. Challenges in defining and categorizing falls on diverse unit types: lessons from expansion of the NDNQI falls indicator. J Nurs Care Qual. 2015;30(2):106-112.
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