Falls on an Inpatient Rehabilitation Unit: Risk Assessment and Prevention

Abstract

The rate of falls on an IRF will be determined in part by the case mix and functional levels of the patients on the unit. Strict adherence to appropriate nursing protocols can reduce the rate of falls.

A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

“…Moreover, as a subset of diagnosis-related groups (DRG) in mixed rehabilitation settings, patients with a TBI have been identified as at a particularly high risk of falling. [5][6][7] This is primarily due to the heterogeneous nature of TBI neurotrauma and associated multisystem sequelae.Being described as a silent epidemic, 8 TBI is a significant social issue often resulting in ongoing disability 9 that is frequently encountered in the rehabilitation setting. 10 To date, there has been little research into the characteristics of patients who fall in this particular inpatient setting.…”

“…Moreover, as a subset of diagnosis-related groups (DRG) in mixed rehabilitation settings, patients with a TBI have been identified as at a particularly high risk of falling. [5][6][7] This is primarily due to the heterogeneous nature of TBI neurotrauma and associated multisystem sequelae.…”

“…A recent study conducted within a community-based residential TBI rehabilitation center identified that total number of medications prescribed, anticholinergic medications, the number of medical complications, dietary restrictions, postinjury coma and coma greater than 24 hours, and bladder/bowel dysfunction were significantly associated with fallers. 11 In mixed inpatient rehabilitation settings where varying proportions of patients with a TBI are being rehabilitated, certain individual Functional Independence Measure (FIM) items, total and subscale scores, 5,7,12 and executive and visuospatial functioning impairments 13 have further been associated with fallers. Perhaps the most salient fall risk variable yet to be studied in the inpatient TBI rehabilitation context is post-traumatic amnesia (PTA).…”

Opinions of Nurses About the Evaluation of Risk of Falling Among Inpatients

“…Nurses indicated that the groups at most risk for falling included the patients in the postoperative period, pediatric patients, patients with neurological problems, unconscious patients, agitated patients, and patients staying in orthopedics departments. Patients with an admission diagnosis of stroke, brain injury, amputation, neurologic disorder, and spinal cord injury are at higher risk for falling than patients whose admission diagnosis related to orthopedic, cardiac, or pulmonary disorders; prolonged stay on medical or surgical units; or trauma without spinal cord injury or head injury (Forrest et al, 2012).…”

“…Researchers designed a semi-structured interview form by using open-ended questions based on related literature. (Bemis-Dougherty & Delaune, 2008;Carson & Cook, 2008;Dacenko-Grawe & Holm, 2008;Evans, Hodgkinson, Lambert, Wood, & Kowanko, 1998;Fischer et al, 2005;Forrest et al, 2012;Maki et al, 2011;Mion et al, 2012;Oliver et al, 2010). The nurses were expected to respond to the following questions in the semi-structured interview form.…”