Patient Falls
Definition: A fall occurs when a person unintentionally comes to rest on the ground or below their initial level.
Literature review
The results of a recent study of nine (9) participating hospitals by Krauss et al. (2007) found:
- 7082 patient falls were recorded from 2001-2003.
- 26.4% of the reported falls resulted in injury ranging from minor to major.
- Fall injury added an average of $4000/patient to treatment costs.
- Unassisted falls (no staff present to break the fall) tended to result in injury.
- Injury was associated with falls occurring in bathrooms, hallways, examination/treatment rooms and nurses' stations.
- Women were more likely to be injured in a fall and their injuries were more serious.
A study published in 2004 by Hitcho identified 183 falls over a period of 13 weeks at a 1300 bed academic hospital. Falls in the psychiatric and physical therapy services were excluded.
- Average age of patients who fell was 63.4 years.
- 85% of falls occurred in the patients' rooms.
- 79% of falls occurred without staff to break the fall.
- 59% occurred in the evening or night.
- 50% were elimination-related (e.g. getting up to the bathroom without help).
Factors associated with falls identified by Krauss and Evanoff et al.:
- Gait/balance deficit
- Confusion
- Sedative or hypnotic medication
- Diabetes medication
- Increased patient to nurse ratio
- Up with assistance orders
Joint Commission (2000) reviewed root cause analysis of 22 fatal falls:
- 50% of deaths resulted from head trauma.
- 33% of fatal falls were from a bed, 33% from upper story, window, stairs, etc., 33% walking, in the bathroom or from a commode, chair or gurney.
- 17 of 22 fatalities involved acute intoxication, altered mental state or chronic mental illness.
- History of prior falls, sedation, anticoagulation, recent environmental change and urinary urgency were risk factors.
- Nights, weekends and holidays had disproportionate rate.
- More than half of root cause analyses identified communication (or lack thereof) among care givers as the primary issue.
- 41% root cause analyses identified deficiencies in: patient assessment, care plan, protocol or environmental design as the cause.
- Risk reduction strategies included:
- Improving staff orientation and training
- Fall risk assessment protocol
- Install split bed rail, leave rail at head up/lower half down at night.
- Review medication dose & combinations for adverse effects on cognition and balance
Self-Reported Falls and Fall-Related Injuries Among Persons Aged >65 Years (CDC (MMWR), 3/7/08).
Patient Fall Risk Assessment
Components of the Morse Fall Scale |
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Patient fall risk should be a integral part of the initial nursing assessment in most acute and long-term care settings. In addition, the patient's fall risk should be reassessed whenever a health status change occurs.
The Morse Fall Scale (MFS) is a popular fall risk assessment tool. The MFS has been validated in a number of settings and has been found to be most useful when the intervention cut-off values are adjusted to reflect the fall rate in a particular care setting.
The American Geriatrics Society suggests the “Get Up and Go Test” as an assessment tool for any older person who has experienced a fall. It is a brief test used to identify "at risk" patients who need further evaluation. When you are prepared to break a potential fall, ask your patient to:
Fall reduction resources