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Patient Safety/Quality

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Falls among hospitalized patients of all ages are a persistent problem

Falls among hospital patients are a persistent problem, with 2.3 to 7 falls occurring in U.S. hospitals every 1,000 patient days. About 30 percent of these falls result in injury, and 4 to 6 percent of them result in serious injury. Hospital falls affect both young and old patients, and many of them happen when the patient is alone or involved in elimination-related activities (for example, walking to or from the bathroom or bedside commode, reaching for toilet tissue, or exiting a soiled bed), according to a study supported by the Agency for Healthcare Research and Quality (HS11898).

Researchers at the Washington University School of Medicine in St. Louis interviewed all patients at one hospital who fell over a 13-week period and/or their family members and nurses. They also reviewed adverse event reports and medical records to identify the circumstances and patient characteristics involved in the first fall of the 183 patients who fell during the study period. The average age of patients who fell was 63.4 years, but ages ranged from 17 to 96 years. Many falls occurred when the patients were not assisted (79 percent), in the patient's room (85 percent), during the evening/overnight (59 percent), and while they were walking (19 percent). Nearly half (44 percent) of patients were confused or disoriented at the time they fell.

General muscle weakness was very prevalent among the patients who fell (81 percent), and many had diabetes (39 percent), urinary frequency (36 percent), or lower extremity problems (38 percent). Many of the patients who fell were on medications such as sedatives that could have contributed to a fall. Half of the falls were due to elimination-related activities, which increased the risk of fall-related injury more than two-fold. In 19 percent of bathroom falls and 30 percent of falls involving a bedside commode, the patient was left alone after being assisted to the bathroom or commode. Many patients who fell did not use assistive devices that they regularly used at home. Wet hospital floors and problem furniture or equipment contributed to 16 percent of falls.

For more information, see "Characteristics and circumstances of falls in a hospital setting," by Eileen B. Hitcho, M.S., Melissa J. Krauss, M.P.H., Stanley Birge, M.D., and others, in the July 2004 Journal of General Internal Medicine 19, pp. 732-739.

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