Fall Definitions and Categories:
Definitions and categories of falls enable users to communicate and compare statistics more accurately. Unfortunately, there is no universally accepted definition of a patient fall. In fact, The Joint Commission (TJC) allows each accredited facility to determine what constitutes a patient or resident fall (TJC, 2008).
Some fall definitions are succinct; an event which results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO, 2012). Some are detailed; “loss of upright position that results in landing on the floor, ground or an object or furniture or a sudden, uncontrolled, unintentional, non-purposeful, downward displacement of the body to the floor/ground or hitting another object like a chair or stair” (VA National Center).
Others provide guidance; “fall” refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (e.g., resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for staff intervention, is considered a fall. A fall without injury is still a fall. Unless there is evidence suggesting otherwise, when a resident is found on the floor, a fall is considered to have occurred (DHHS).
Fall categories by cause:
Accidental Falls are attributed to extrinsic environmental risk factors or hazards: spills on the floor, clutter, tubing/cords on the floor, etc., or errors in judgment.
Anticipated Physiological Falls are attributed to risks intrinsic to the patient’s physical status e.g. 1) sensory impairment 2) impaired: balance, gait, mobility, 3) impaired cognition/confusion e.g. polypharmacy, 4) history of falls, 5) elimination dysfunction.
Unanticipated Physiological Falls are associated with intrinsic factors that could not have reasonably been predicted, such as: stroke, heart attack, seizure, etc (Morse, 2009).
Behavioral Falls occur when the patient "who has behavioral issues and voluntarily positions his/her body from a higher level to a lower level" (Neilly et al., (2013).
An assisted fall occurs when the patient begins to fall, is assisted by another person, but nevertheless reaches the ground or other unintended surface. An assisted fall is an incident and not a near miss, since the patient is not prevented from reaching the ground or unintended surface (AHRQ).
Falls categorized by effect:
Non-injurious falls are those that result in no physical harm. However, psychological effects that inhibit mobility for fear of future fall injury should be assessed.
Injurious falls result in physical harm. They are typically less frequent than non-injurious falls. The rate of injurious falls is an important safety metric.
Fall Injury classifications:
Standardized reporting of inpatient fall injury is commonly characterized using National Database of Nursing Quality Indicators (NDNQI®) which include the following injury categories:
"None—patient had no injuries (no signs or symptoms) resulting from the fall, if an x-ray, CT scan or other post fall evaluation results in a finding of no injury.
Minor—resulted in application of a dressing, ice, cleaning of a wound, limb elevation, topical medication, bruise or abrasion.
Moderate—resulted in suturing, application of steri-strips/skin glue, splinting or muscle/joint strain.
Major—resulted in surgery, casting, traction, required consultation for neurological (basilar skull fracture, small subdural hematoma) or internal injury (rib fracture, small liver laceration) or patients with coagulopathy who receive blood products as a result of the fall.