Kontakt 2019, 21(2):114-120 | DOI: 10.32725/kont.2019.004

Factors associated with falls in hospitals: outcomes for nursing careNursing - Original article

Hana Hajduchová1,*, Iva Brabcová1, Valérie Tóthová1, Sylva Bártlová1, Martin Doseděl2, Josef Malý2, Jiří Vlček2
1 University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, České Budějovice, Czech Republic
2 Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy, Hradec Králové, Czech Republic

Aim: The aim of this research was to carry out an analysis of falls of hospitalized patients in 2017. They occurred at 16 selected wards in 4 hospitals in South Bohemia. The falls of hospitalized patients are the most frequent negative events in hospitals.

Materials and methods: The data regarding falls in hospitals were coded and databased by authorized employees in "Monitoring of the risk factors of falls and their analysis". They were later statistically analysed using the SASD programme. A total of 280 falls were analysed.

Results: Most falls occurred at subsequent care wards - 48.9%. 44.3% of falls occurred at internal wards and 6.8% at surgical wards. Almost half (46.5%) concerned patients who had been hospitalized for 1 to 7 days. The average age of the patients who had fallen was 76.9 years. Most falls occurred in patients' rooms - 78.0% and, in 93.3% of the cases, a medical worker was not present when the fall occurred. In the last 12 months, more than one third of patients have experienced a fall (39.8%). The riskiest period of the day was between 22:00 and 5:59 (35.8% of falls). Most frequently (31.6%), a patient fell off their bed. 41.8% of patients were not injured. The most frequent internal cause was imbalance or dizziness (57.1%) and 34.4 % suffered from confusion.

Conclusions: Considering the above-mentioned results, we recommend a change in the control system and interventions using IT technologies and systems.

Keywords: Fall analysis; Czech Republic; Hospitalized patients; Nursing care; Risk factors

Received: August 28, 2018; Accepted: December 11, 2018; Prepublished online: January 30, 2019; Published: June 17, 2019  Show citation

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Hajduchová H, Brabcová I, Tóthová V, Bártlová S, Doseděl M, Malý J, Vlček J. Factors associated with falls in hospitals: outcomes for nursing care. Kontakt. 2019;21(2):114-120. doi: 10.32725/kont.2019.004.
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    References

    1. Abreu C, Mendes A, Monteiro J, Santos FR (2012). Falls in hospital settings: a longitudinal study. Rev Lat Am Enfermagem 20(3): 597-603. DOI: 10.1590/S0104-11692012000300023. Go to original source... Go to PubMed...
    2. Ang E, Mordiffi SZ, Wong HB (2011). Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. J Adv Nurs 67(9): 1984-1992. DOI: 10.1111/j.1365-2648.2011.05646.x. Go to original source... Go to PubMed...
    3. Barker AL, Morello RT, Wolfe R, Brand CA, Haines TP, Hill KD, et al. (2016). 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ 352: h6781. DOI: 10.1136/bmj.h6781. Go to original source... Go to PubMed...
    4. Barrett MB, Vizgirda VD, ZhouY (2017). Registered nurse and patient care technician perceptions of toileting patients at high fall risk. Medsurg Nursing 26(5): 317-323.
    5. Bayen E, Jacquemot J, Netscher G, Agrawal P, Tabb Noyce L, Bayen A (2017). Reduction in fall rate in dementia managed care through video incident review: Pilot Study. J Med Internet Res 19(10): e339. DOI: 10.2196/jmir.8095. Go to original source... Go to PubMed...
    6. Bittencourt VLL, Graube SL, Stumm EMF, Battisti IDE, Loro MM, Winkelmann ER (2017). Factors associated with the risk of falls in hospitalized adult patients. Rev Esc Enferm USP 51:e03237. DOI: 10.1590/S1980-220X2016037403237. Go to original source... Go to PubMed...
    7. Bóriková I, Žiaková K, Tomagová M, Záhumenská J (2018). The risk of falling among older adults in long-term care: screening by the Morse Fall Scale. Kontakt 20(2): e111-e119. DOI: 10.1016/j.kontakt.2017.11.006. Go to original source...
    8. Bradley SM, Karani R, McGinn T, Wisnivesky J (2010). Predictors of serious injury among hospitalized patients evaluated for falls. J Hosp Med 5(2): 63-68. DOI: 10.1002/jhm.555. Go to original source... Go to PubMed...
    9. Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N (2010). Interventions for preventing falls in olderpeople in nursing care facilities and hospitals. Cochrane Database SystRev 20(1): CD005465. DOI: 10.1002/14651858.CD005465.pub2. Go to original source... Go to PubMed...
    10. Chang CM, Chen MJ, Tsai CY, Ho LH, Hsieh HL, Chau YL, Liu CY (2011). Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study. Int J Geriatr Psychiatry 26(6): 602-607. DOI: 10.1002/gps.2569. Go to original source... Go to PubMed...
    11. Clyburn TA, Heydemann JA (2011). Fall prevention in theelderly: Analysis and Comprehensive Review of Methods Used in the Hospital and in the Home. J Am Acad Orthop Surg 19(7): 402-409. DOI: 10.5435/00124635-201107000-00003. Go to original source... Go to PubMed...
    12. Cox J, Thomas-Hawkins C, Pajarillo E, De Gennaro S, Cadmus E, Martinez M (2015).Factors associated with falls in hospitalized adult patients. Appl Nurs Res 28(2): 78-82. DOI: 10.1016/j.apnr.2014.12.003. Go to original source... Go to PubMed...
    13. Cumbler E, Likosky D (2011). In-hospital falls: Evaluation and response. Continuum (Minneap Minn) 17(5): 1063-1076. DOI: 10.1212/01.con.0000407060.48155.05. Go to original source... Go to PubMed...
    14. Cumming RG, Sherrington C, Lord SR, Simpson JM, Vogler C, Cameron ID, Naganathan V (2008). Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ 336(7647): 758-760. DOI: 10.1136/bmj.39499.546030.BE. Go to original source... Go to PubMed...
    15. Cuttler SJ, Barr-Walker J, Cuttler L (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ Open Qual 6(2): e000119. DOI: 10.1136/bmjoq-2017-000119. Go to original source... Go to PubMed...
    16. Dunne TJ, Gaboury I, Ashe MC (2014). Falls in hospital increase length of stay regardless of degree of harm. J Eval Clin Pract 20(4): 396-400. DOI:10.1111/jep.12144. Go to original source... Go to PubMed...
    17. Dykes PC, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F, Middleton B (2010). Fall prevention in acute care hospitals: a randomized trial. JAMA 304(17): 1912-1918. DOI: 10.1001/jama.2010.1567. Go to original source... Go to PubMed...
    18. Gallardo AM, Morales-Asencio Asencio JM, Canca-Sanchez JC, Barrero-Sojo S, Perez-Jimenez C, Morales-Fernandez, et al. (2013). Instruments for assessing the risk of falls in acute hospitalized patients: A systematic review protocol. J Adv Nurs 69(1): 185-193. DOI: 10.1111/j.1365-2648.2012.06104.x. Go to original source... Go to PubMed...
    19. Ganz DA, Huang C, Saliba D, Shier V (2013). Preventing falls in hospitals: A toolkit for improving quality of care. RAND Corporation, Boston University School of Public Health and ECRI. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication no. 13-0015-EF.
    20. Godlock G, Christiansen M, Feider L (2006). Implementation of an evidence-based patient safety team to prevent falls in inpatient medical units. Medsurg Nurs 25(1): 17-23.
    21. Härlein J, Halfens RJ, Dassen T, Lahmann NA (2011). Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies. J Clinical Nurs 20: 175-183. DOI: 10.1111/j.1365-2702.2010.03460.x. Go to original source... Go to PubMed...
    22. Healey F (2016). Preventing falls in hospitals: Tackling risk factors should be a clinical priority. BMJ: 352. DOI: 10.1136/bmj.i251. Go to original source... Go to PubMed...
    23. Healey F, Darowski A (2012). Older patients and falls in hospital. Clinical Risk 18(5): 170-176. DOI: 10.1258/cr.2012.012020. Go to original source...
    24. Healey F, Scobie S (2007). Slips, trips and falls in hospital. Patient Safety Observatory, 3rd report. London: National Patient Safety Agency.
    25. Hefner JL, McAlearney AS, Mansfield J, Knupp AM, Moffatt-Bruce SDA (2015). Falls wheel in a large academic medical center: An intervention to reduce patient falls with harm. J Healthc Qual 37(6): 374-380. DOI: 10.1097/JHQ.0000000000000011. Go to original source... Go to PubMed...
    26. Hitcho EB, Krauss MJ, Birge S, Dunagan WD, Fischer I, Johnson S, et al. (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. J Gen Inter Med 19(7): 732-739. DOI: 10.1111/j.1525-1497.2004.30387.x. Go to original source... Go to PubMed...
    27. Horová J, Brabcová I, Krocová J (2017). The effectiveness of intervention programs for preventing patients from falls. Kontakt 19(2): 105-115. DOI: 10.1016/j.kontakt.2017.04.003. Go to original source...
    28. Jørgensen TSH, Hansen AH, Sahlberg MIE, Gislason GH, Torp-Pedersen C, Andersson C, Holm E (2015). Nationwide time trends and risk factors for in-hospital falls-related major injuries. Int J Clin Pract 69(6): 703-709. DOI: 10.1111/ijcp.12624. Go to original source... Go to PubMed...
    29. Kang YO, Song R (2015). Identifying characteristics of fall episodes and fall-related risks of hospitalized patients. Journal of Muscle and Joint Health 22(3): 149. DOI: 10.5953/JMJH.2015.22.3.149. Go to original source...
    30. Katsulis Z, Ergai A, Leung WY, Schenkel L, Rai A, Adelman J (2010). Iterative user centered design for development of a patient-centered fall prevention toolkit. Applied Ergonomics 56: 117-126. DOI: 10.1016/j.apergo.2016.03.011. Go to original source... Go to PubMed...
    31. King B, Pecanac K, Krupp A, Daniel Liebzeit D, Mahoney J (2018). Impact of fall prevention on nurses and care of fall risk patients. Gerontologist 58(2): 331-340. DOI: 10.1093/geront/gnw156. Go to original source... Go to PubMed...
    32. Lamis RL, Kramer JS, Hale LS, Zackula RE, Berg GM (2012). Fall risk associated with inpatient medications. Am J Health Syst Pharm 69: 1888-1894. DOI: 10.2146/ajhp110723. Go to original source... Go to PubMed...
    33. Lang AR, Kwok TC, Fioratou E, LeJeune I, Sharples S (2014). User-centred design of patient information for hospital admissions and patient experience. In: Sharples S, Shorrock S (Eds). Contemporary Ergonomics and Human Factors. CRC Press, pp. 203-210. Go to original source...
    34. Lee DCA, Pritchard E, McDermott F, Haines TP (2014). Falls prevention education for older adults during and after hospitalization: a systematic review and meta-analysis. Health Educ J 73: 530-544. DOI: 10.1177/0017896913499266. Go to original source...
    35. Luzia MF, Argenta C, Almeida MA, Lucena AF (2018). Conceptual definitions of indicators for the nursing outcome "Knowledge: Fall Prevention". Rev Bras Enferm 71(2): 431-439. DOI: 10.1590/0034-7167-2016-0686. Go to original source... Go to PubMed...
    36. Mazur K, Wilczyński K, Szewieczek J (2016).Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clin Interv Aging 11: 1253-1261. DOI: 10.2147/CIA.S115755. Go to original source... Go to PubMed...
    37. McKechnie D, Pryor J, Fisher MJ (2017). Predicting falls in the inpatient setting. JARNA 20(3): 14-19.
    38. Oliver D, Healey F, Haines T (2010). Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med 26(4): 645-692. DOI: 10.1016/j.cger.2010.06.005. Go to original source... Go to PubMed...
    39. Oliver D, Hopper A, Seed P (2000). Do hospital fall prevention programs work? A systematic review. J Am Geriatr Soc 48: 1679-1689. DOI:10.1111/j.1532-5415.2000.tb03883.x. Go to original source... Go to PubMed...
    40. Pokojová R, Bártlová S (2018). Ensuring a sufficient number of personnel as part of the safety culture in medical facilities. Kontakt 20(1): e11-e16. DOI: 10.1016/j.kontakt.2017.10.002. Go to original source...
    41. Pokorná A, Búřilová P, Štrombachová V, Dolanová D (2017). Centrální systémové hlášení nežádoucích událostí - Metodika Nežádoucí událost, PÁD. Ústav zdravotnických informací a statistiky ČR. [online] [cit. 2018-07-15]. Available from: http://shnu.uzis.cz/res/file/metodicke_dokumenty/pad_metodika_plna_verze_metodiky(1).pdf
    42. Rheaume J, Fruh S (2015). Retrospective cases reviews of adult inpatient falls in the acute care setting. Medsurg Nurs 24(5): 318-324. Go to PubMed...
    43. Shumba C, Abraham S (2017). Patient falls in the acute care hospital setting as perceived by the frontline staff. Prensa Med Argent 103(3). DOI: 10.4172/lpma.1000251. Go to original source...
    44. Schwendimann R, Bühler H, Geest S, Milisen K (2008). Characteristics of hospital inpatient falls across clinical departments. Gerontology 54(6): 342-348. DOI: 10.1159/000129954. Go to original source... Go to PubMed...
    45. Tinetti ME, Kumar C (2010). The patient who falls: "It's always a trade-off" JAMA 303(3): 258-266. DOI: 10.1001/jama.2009.2024. Go to original source... Go to PubMed...
    46. Topinková E (2005). Geriatrie pro praxi. Praha: Galén.
    47. Twibell RS, Siela D, Sproat T, Coers G (2015). Perceptions related to falls and fall prevention among hospitalized adults. Am J Crit Care 24(5): e78-85. DOI: 10.4037/ajcc2015375. Go to original source... Go to PubMed...
    48. Tzeng HM (2010). Inpatient falls in adult acute care settings: influence of patients' mental status. J Adv Nurs 66(8): 1741-1746. DOI: 10.1111/j.1365-2648.2010.05343.x. Go to original source... Go to PubMed...
    49. Tzeng HM, Yin CY (2014). Engaging as an innovative approach to engage patients in their own fall prevention care. Patient Prefer Adherence 8: 693-700. DOI: 10.2147/PPA.S62746. Go to original source... Go to PubMed...
    50. Vivanti A, Ward N, Haines T (2011). Nutritional status and associations with falls, balance, mobility and functionality during hospital admission. J Nutr Health 15(5): 388-391. DOI: 10.1007/s12603-010-0302-8. Go to original source... Go to PubMed...
    51. Votruba L, Graham B, Wisinski J, Syed A (2016). Video monitoring to reduce falls and patient companion costs for adult inpatients. Nurs Econ 34(4): 185-189.
    52. Williams T, Szekendi M, Thomas S (2014). Ananalysis of patient falls and fall prevention programs across academic medical centers. J Nurs Care Qual 29(1): 19-29. DOI: 10.1097/NCQ.0b013e3182a0cd19. Go to original source... Go to PubMed...
    53. Wong CA, Recktenwald AJ, Jones ML,Waterman BM, Bollini ML, Dunagan WC (2011). The cost of serious fall-related injuries at three Midwestern hospitals. Jt Comm J Qual Patient Saf 37(2): 81-87. DOI: 10.1016/S1553-7250(11)37010-9. Go to original source... Go to PubMed...
    54. Zhao YL, Kim H (2015). Older adult inpatient falls in acute care hospitals: intrinsic, extrinsic, and environmental factors. J Gerontol Nurs 41(7): 29-43. DOI: 10.3928/00989134-20150616-05. Go to original source... Go to PubMed...

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