Analysis of non-injurious and injurious inpatient hospital falls in an acute hospital in Hong Kong

Abstract

Background: In-patient hospital fall is a major patient safety concern in hospitals accounting for up to nearly a third of all reported patient safety incidents. Up to 50% of falls were injurious falls. Even non-injurious falls cause distress and anxiety to patients and carers resulting in reduced mobility for patients. Objective: To analyse non-injurious and injurious in-patient hospital falls in an acute hospital in Hong Kong by observing patient characteristics and predictors of in-patient falls, comparing falls resulting in different severity indices, comparing non-injurious and injurious falls, and examining in details of falls with moderate to high severity indices. Methods: A retrospective descriptive study that looked at all adult in-patient hospital falls across specialties in 2013 reported through the Advanced Incident Reporting System (AIRS) in United Christian Hospital, a 1200-bed acute hospital in Hong Kong. Data including patient characteristics, severity index of fall, risk factors of fall, activity at the time of fall, mechanism of fall, and intervention in place at the time of fall were collected using a structured data set through review of AIRS reports and medical records. Results: A total of 232 in-patient fall episodes were included in the study. The total fall rate per 1000 occupied bed days was 0.71. 74% were aged 65 years and older; 58% fell in Medical and Geriatric wards; 32% fell in Surgical or Orthopaedic wards; 10% fell in other wards. 41% of falls were non-injurious falls and 59% of falls were injurious falls. There were significantly more injurious falls compared to non-injurious falls in surgery and orthopaedic departments compared to other departments (p=0.002). 26% of patients fell between the hours of 22:00 and 01:59. 44% of total in-patient falls and 47% of injurious falls were related to toileting and continence care. Conclusion: Fall prevention strategies should be implemented across specialties including surgical and orthopaedic departments. Special attention should be addressed during the first four hours of the nursing night shift, especially in high-risk patients. An individualised care bundle focusing on toileting and continence issues should be implemented in high-risk patients as part of a fall prevention strategy in order to reduce in-patient hospital falls. An effective intervention to prevent fall involves a multidisciplinary individualised approach.

Background: In-patient hospital fall is a major patient safety concern in hospitals accounting for up to nearly a third of all reported patient safety incidents. Up to 50% of falls were injurious falls. Even non-injurious falls cause distress and anxiety to patients and carers resulting in reduced mobility for patients. Objective: To analyse non-injurious and injurious in-patient hospital falls in an acute hospital in Hong Kong by observing patient characteristics and predictors of in-patient falls, comparing falls resulting in different severity indices, comparing non-injurious and injurious falls, and examining in details of falls with moderate to high severity indices. Methods: A retrospective descriptive study that looked at all adult in-patient hospital falls across specialties in 2013 reported through the Advanced Incident Reporting System (AIRS) in United Christian Hospital, a 1200-bed acute hospital in Hong Kong. Data including patient characteristics, severity index of fall, risk factors of fall, activity at the time of fall, mechanism of fall, and intervention in place at the time of fall were collected using a structured data set through review of AIRS reports and medical records. Results: A total of 232 in-patient fall episodes were included in the study. The total fall rate per 1000 occupied bed days was 0.71. 74% were aged 65 years and older; 58% fell in Medical and Geriatric wards; 32% fell in Surgical or Orthopaedic wards; 10% fell in other wards. 41% of falls were non-injurious falls and 59% of falls were injurious falls. There were significantly more injurious falls compared to non-injurious falls in surgery and orthopaedic departments compared to other departments (p=0.002). 26% of patients fell between the hours of 22:00 and 01:59. 44% of total in-patient falls and 47% of injurious falls were related to toileting and continence care. Conclusion: Fall prevention strategies should be implemented across specialties including surgical and orthopaedic departments. Special attention should be addressed during the first four hours of the nursing night shift, especially in high-risk patients. An individualised care bundle focusing on toileting and continence issues should be implemented in high-risk patients as part of a fall prevention strategy in order to reduce in-patient hospital falls. An effective intervention to prevent fall involves a multidisciplinary individualised approach.