A case-control study of patient, medication, and care-related risk factors for inpatient falls

Abstract

OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/ or nurses and review of adverse event reports, medical records, and nurse staffing records.SETTING: Large urban academic hospital.PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall. MEASUREMENTS AND MAIN RESULTS:In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of ''up with assistance'' compared with ''bathroom privileges'' (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling. Due to the risk of significant injury and the increased cost, reduction of falls in hospitals is a major priority for hospital quality and patient safety. While falls have been relatively well studied in community and nursing home settings, less is known about the prevention of hospital falls. Previous research has identified risk factors for falling in the hospital, including impaired balance or gait, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, urinary frequency, nocturia, incontinence, specific diagnoses, and use of certain medications, such as benzodiazepines, antipsychotics, and sedatives. 10,[12][13][14][15][16][17][18] Yet comparative studies on hospital falls have been limited in several ways, including variations in study design, setting, patient population, and definitions of risk factors. Some studies have continued to focus solely on the elderly or relied only on data included in hospital incident reports or chart review. Furthermore, environmental and care-related factors, including patient-to-nurse ratio, are often overlooked as potential risk factors for falling in these studies. Because fall prevention programs should be linked to the etiologic factors of fa...

Meta‐analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population

“…31 The most consistently reproducible patient-related risks are altered mental status (including cognitive impairment and depression), altered mobility (particularly lower limb weakness), a history of falls, and toileting needs. 13,[32][33][34][35][36] Less consistency is seen with other traditional risk factors such as age, sedating medication, and length of stay. 5,13,32,[36][37][38] Attempting to risk-stratify patients using simple and accurate assessment tools developed from these risk factors has proven to be very difficult.…”

“…13,[32][33][34][35][36] Less consistency is seen with other traditional risk factors such as age, sedating medication, and length of stay. 5,13,32,[36][37][38] Attempting to risk-stratify patients using simple and accurate assessment tools developed from these risk factors has proven to be very difficult. Many tools have been developed based on identified risk factors, but perform very poorly when trying to identify patients who will fall with reasonable specificity and positive predictive value.…”

Predictors of serious injury among hospitalized patients evaluated for falls

“…1 Approximately 30% of such falls result in injury and up to 6% may be serious in nature. 1,2 These injuries can result in pain, functional impairment, disability, or even death, and can contribute to longer lengths of stay, increased health care costs, and nursing home placement. [2][3][4][5] As a result, inpatient falls have become a major priority for hospital quality assurance programs, and hospital risk management departments have begun to target inpatient falls as a source of legal liability.…”

“…1,2 These injuries can result in pain, functional impairment, disability, or even death, and can contribute to longer lengths of stay, increased health care costs, and nursing home placement. [2][3][4][5] As a result, inpatient falls have become a major priority for hospital quality assurance programs, and hospital risk management departments have begun to target inpatient falls as a source of legal liability. [1][2][3]6,7 Recently, the Centers for Medicare and Medicaid Services announced that it will no longer pay for preventable complications of hospitalizations, including falls and fallrelated injury.…”

“…[2][3][4][5] As a result, inpatient falls have become a major priority for hospital quality assurance programs, and hospital risk management departments have begun to target inpatient falls as a source of legal liability. [1][2][3]6,7 Recently, the Centers for Medicare and Medicaid Services announced that it will no longer pay for preventable complications of hospitalizations, including falls and fallrelated injury. 8 Much of the literature on falls comes from community and long-term care settings, and only a few studies have investigated falls during acute care hospitalization.…”