A Large Study of Inpatient Falls and Falls Prevention Across Academic Medical Centers
The University Healthsystem Consortium (UHC) in Chicago conducted a retrospective review of 154,618 inpatient falls that occurred from 2004 through 2010 in order to identify factors associated with falls and determine the effectiveness of falls prevention programs. Trends in patient falls, fall rates, and several fall-related parameters, as well as falls risk assessment tools and prevention strategies were evaluated. Data from 40 organizations were used for the trends analysis.
The analysis of inpatient falls showed significant reductions in fall rate following introduction of The Joint Commission National Patient Safety Goals in 2005. Reported falls per 1000 staffed beds declined 20% by 2010, and there was a corresponding decrease in both harmful falls and falls requiring life-sustaining intervention (27% and 34%, respectively).
A further retrospective review of 2010 falls data reported by 76 organizations validated current knowledge and also provided new information relevant to falls prevention. Review of 25,510 falls revealed that 75% of all falls occurred in 1 of 11 locations, including medical-surgical units (15%), medical units (11%), adult psychiatric units (11%), rehabilitation units (10%), and emergency departments (6%). Applying the National Database of Nursing Quality Indicators, 76% of the falls that occurred in 2010 did not result in injury, 21% resulted in minor injury, and 2% in moderate injury (eg, requiring suture or splinting). There were 172 high-harm falls (<1%) in 2010, resulting in a major injury or death. Ambulating and toileting were the most common fall-related activities; the most common fall-related patient factors were altered mental status, inability to rise without assistance, and altered elimination. Medication was another parameter affecting falls. Patients receiving pain medication (29%), cardiac and antihypertensive drugs (25%), sedatives (20%), and antipsychotics/antidepressants (15%) were common fallers; 17% of patients who fell were taking 3 or more of these medications. Compared with all patients who fell, fallers who sustained major injury or death were twice as likely to be taking diuretics. Examination of fall risk assessment and prevention strategies demonstrated high levels of use. Of the patients who fell, 88% had been assessed for fall risk and 80% identified as high risk. Younger patients were less likely to be assessed for fall risk. Dizziness/vertigo was the most common cause of falling in patients who had been assessed as low fall risk. The Morse Fall Score (44%), in-house created tools (29%), and the Hendrich II Fall Risk Model (21%) were the most frequently used falls risk assessment tools. In pediatric settings, the Humpty Dumpty Fall Risk Assessment was used by 68% of the organizations. Fall prevention strategies that were in place at the time of a patient fall included low bed position, patient education, fall alerts, toileting schedule, among others. Survey of clinicians identified practices deemed to have the greatest impact on reducing falls: standardized risk assessment, environmental alerts, frequent rounds, fall prevention committee/team, and engagement of senior leadership. This large study presents detailed data on inpatient falls by level of injury/age, risk assessments by age and location, and components of fall prevention programs across many institutions. Williams T, Szekendi M, Thomas S. An analysis of patient falls and fall prevention programs across academic medical centers. J Nurs Care Qual. 2013:Epub. 1-11. Study information also available at: https://www.uhc.edu/docs/49017417_FallPreventionPosterHandout.pdf
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