Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing

Staggs, Vincent S.; Dunton, Nancy

doi:10.1093/intqhc/mzt080

Cited by 49 publications

(67 citation statements)

References 16 publications

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“…This translated to a decreased incidence of falls when there were more RNs working on the unit with a larger portion having worked on the particular unit for a long time. Staggs & Dunton (2014) This study revealed that higher RN hours per patient day were associated with decreased unassisted fall rates (n = 2567, p = 0.015) on medical-surgical units. All unit types except for rehabilitation units including step-down (n = 1557, p = <0.001), medical (n = 2010, p = <0.001), medical-surgical (n = 2567, p = <0.001), and surgical (n = 1395, p = 0.005) were noted to have increased unassisted fall rates with higher non-RN hours per patient day.…”

Section: Nurse Staffingmentioning

confidence: 70%

Nurses' Perceptions of Nurse Staffing and the Impact on Patient Falls

Henry

2014

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Patient falls contribute to unnecessary injury and incapacitation for patients and are also a major source of stress for the nurses caring for patients who fall. Hospitals are no longer being reimbursed for extended hospital stays related to injuries caused by patient falls and action is needed to decrease such events. Nurse staffing has been shown to play a critical role in determining the incidence of patient falls, with better nurse staffing decreasing the likelihood of a patient falling. The purpose of this study was to determine nurses' perceptions of nurse staffing and its impact on the incidence of patient falls. The methodology included a short, self-administered survey developed by the researcher.Nurses answered 15 questions related to the number of patients they cared for, number of patient falls, and factors that could influence falls. Nurses who completed the survey reported caring for between 2-7 patients on their last shift and reported between 0-2 falls on their assignment within the previous three months. Nurses indicated that factors such as admission and discharge activity, the number of available staff on the unit, and the acuity of patients on the unit impacted patient falls. Further research is needed to determine the relationship between nurse staffing and the incidence of patient falls.Advanced Practice Registered Nurses (APRNs) are in an ideal position to participate in research related to this topic as well to advocate for nursing's role in preventing patient falls.

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Section: Nurse Staffingmentioning

confidence: 70%

Nurses' Perceptions of Nurse Staffing and the Impact on Patient Falls

Henry

2014

Preprint

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“…This is further evidence that the type of nursing staff, not just the number of staff per patient, can be important for patient outcomes 2122 , 31 – 33 Nurses must obtain a physician order for restraint, and having an adequate proportion of RNs apparently reduces the likelihood of nursing staff requesting such an order, perhaps because RNs are better trained to find alternatives to restraint. In any case, restraint involves both nurses and physicians, and reduction in restraint use must be a collaborative effort.…”

Section: Discussionmentioning

confidence: 99%

Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study

et al. 2016

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BackgroundAlthough it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units.ObjectiveTo conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit’s long-term average is associated with restraint use.DesignWe analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit’s average staffing across study quarters.Subjects3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006–2010. Units had to report at least one quarter with restraint use and one quarter without.Main MeasuresWe studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention.Key ResultsNursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3–29 %) and 18 % (95 % CI: 8–29 %) higher for quarters with very low skill mix.ConclusionsIn this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.

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“…Roughly 80%–90% of falls are unassisted, 11,1823–25 the proportion depending in part on the type of unit studied, 23,24 hospital type (academic or nonacademic) and location (rural or urban/suburban), 11 and whether falls by patients using an assistive device are counted as unassisted. 18 Classifying falls as assisted or unassisted is generally straightforward and requires minimal effort, but it has not been shown that this classification is associated with processes of care.…”

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confidence: 99%

Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care

Staggs

Mion

Shorr

2014

The Joint Commission Journal on Quality and Patient Safety

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Background Many hospitals classify inpatient falls as assisted (if a staff member is present to ease the patient’s descent or break the fall) or unassisted for quality measurement purposes. Unassisted falls are more likely to result in injury, but there is limited research quantifying this effect or linking the assisted/unassisted classification to processes of care. A study was conducted to link the assisted/unassisted fall classification to both processes and outcomes of care, thereby demonstrating its suitability for use in quality measurement. This was only the second known published study to quantify the increased risk of injury associated with falling unassisted (versus assisted), and the first to estimate the effects of falling unassisted (versus assisted) on the likelihood of specific levels of injury. Methods A cross-sectional analysis of falls from all available 2011 data for 6,539 adult medical, surgical, and medical-surgical units in 1,464 general hospitals participating in the National Database of Nursing Quality Indicators® (NDNQI®) was performed. Results Participating units reported 166,883 falls (3.44 falls per 1,000 patient-days). Excluding repeat falls, 85.5% of falls were unassisted. Assisted and unassisted falls were associated with different processes and outcomes: Fallers in units without a fall prevention protocol in place were more likely to fall unassisted than those with a protocol in place (adjusted odds ratio [aOR], 1.39 [95% confidence interval (CI), 1.32, 1.46]), and unassisted falls were more likely to result in injury (aOR, 1.59 [95% CI, 1.52, 1.67]). Conclusions The assisted/unassisted fall classification is associated with care processes and patient outcomes, making it suitable for quality measurement. Unassisted falls are more likely than assisted falls to result in injury and should be considered as a target for future prevention efforts.

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Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing

Cited by 49 publications

References 16 publications

Nurses' Perceptions of Nurse Staffing and the Impact on Patient Falls

Nurses' Perceptions of Nurse Staffing and the Impact on Patient Falls

Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study

Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care

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