Untitled Document

Measurement of Falls

A standardized inpatient fall rate calculation facilitates comparison of fall rates within and between healthcare facilities. According to Dunton et al., 2004) acute care facility fall rates average 3.73 per 1,000 patient days. The fall rate is usually reported as the number of falls reported by staff in one thousand patient days. Short stay units may have to calculate 24 hour occupancy to determine patient days.

Measure	Formula	Example
Fall rate	Patient falls x 1,000 Patient days	Unit falls for February Patient falls = 3 (14 occupied beds X 28 Days) = Patient days = 392 = 0.0076 X 1000 =7.6
Fall injury rate	Patient fall Injuries x 1,000 Patient days	Unit fall injuries in February Fall injuries = 1 (14 occupied beds X 28 Days) = Patient days = 392 = 0.00255 X 1000 = 2.55

Injuries associated with inpatient falls are important patient safety indicators. Falls that result in patient death or significant disability occurring while being cared for in a health care setting are reportable Sentinel Events (TJC, 2015). http://www.jointcommission.org/assets/1/18/SEA_55.pdf

Determining an accurate fall rate for the unit

Injuries associated with inpatient falls are important patient safety indicators. Falls that result in patient death or significant disability occurring while being cared for in a health care setting are reportable Joint Commission Sentinel Events (JCHO, 2015). http://www.jointcommission.org/assets/1/18/SEA_55.pdf

In a study by Schorr et al., (2008) educated nurse fall evaluators were used. These evaluators were available 24 hours a day, seven days a week throughout the study. Nursing staff were instructed to page these evaluators when a fall occurred. During this study 191 falls were reported in incident reports. However, 228 falls were reported to the evaluators. When they combined the falls from both data sources, 266 falls had occurred. The authors suggested incident reports not be the sole sourse of data for evaluation of fall reduction programs.

Waters et al. (2013) completed a prospective study of falls and fall related injuries documented by a fall evaluator, hospital incident report and discharge ICD-9-CM codes during an episode of inpatient care in medical and surgical units. The researchers found 90.2% of the falls with injury resulted in temporary harm with the remaining 9.8% (37) of the falls with injuries leading to more serious injuries. Of the 37 falls with serious injuries only 16 were identified using the ICD-9-CM codes, with 1/3 being outside the CMS targeted injury code ranges. The authors suggest these CMS targeted codes when used to identify fall related injuries are not the most accurate. This may change with the introduction of the ICD-10-CM coding system.

Instant feedback

Comparing more than one fall data collection method results in the most accurate unit fall rate.

©RnCeus.com

Reference

Dunton, N., Gajewski, B, Taunton, R.L., & Moore, J. (2004). Nurse staffing and patient falls on acute care hospital units. Nursing Outlook, 52, 53–9.
The Joint Commission (TJC). (2015). Sentinel Event Alert Preventing falls and fall-related injuries in health care facilities. Issue 55, September 28, 2015. 12/10/2015 retrieved from
http://www.jointcommission.org/assets/1/18/SEA_55.pdf
Shorr, R. I., Chandler, M., Mion, L. C., Waters. T. M., Minshao, L., Daniels, M. J. et al. (2012). Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients. Ann Intern Med. 157(10), 692–699.
Waters, T. Chandler, M. A., Mion, L.C., Daniels, M. J., Lessler, L., Miller, S. T., & Shorr, R. (2013). Use of ICD-9-CM Codes to Identify Inpatient Fall-Related Injuries. J Am Geriatr Soc. 61(12).