Implementation of Fall Preventions Over the Past 15 Years: Impact on Inpatient Injury and Insights for the Future.

BACKGROUND: Hospital fall rates have changed minimally with preventive measures; however, the effect on injury rate is unclear. PURPOSE: The purpose was to determine whether fall-related injuries have changed over time. METHODS: A retrospective comparison was done of 1134 adult inpatient falls in 2017 to 1235 falls in 2001-2002 for injury and fall circumstances. Separate comparisons were made of patient characteristics by service line for 2017. RESULTS: Severe fall injuries declined from 6% to 2.4%. Elimination issues remained the most common circumstance (38.9% and 42%). In 2017, malnutrition (31.6%), low function (61.4%), fall history (26.3%), and use of high-risk medications (83.2%) were common in patients who fell. Predictors of falls with injury by patient population were as follows: surgery-male gender (P = .01), low function (P = .006), elimination issues (P = .04); oncology-low function (P = .04); and neurology-low function (P = .02). CONCLUSIONS: Severe fall-related injuries have decreased in the past 15 years. The most common circumstance for falls remains elimination issues.

Anatomy of Inpatient Falls: Examining Fall Events Captured by Depth-Sensor Technology.

BACKGROUND: Sensor technology offers a new way to identify patient movement, detect falls, and automatically alert health care staff when falls occur. The information gained from analyzing actual fall events can be beneficial in developing individualized fall prevention strategies, informing nursing staff about the nature of falls, and identifying opportunities to make the patient care environment safer. METHODS: A six-month performance improvement pilot was conducted at Barnes-Jewish Hospital (St. Louis) to assess the ability of a depth-sensor system to capture inpatient fall events within patient hospital rooms. Depth sensors were installed on two inpatient medicine units with a history of high fall rates. The depth sensors captured actual fall events on video. Video clips were reviewed and analyzed to identify the characteristics of patient falls, staff response times, and environmental conditions contributing to falls. RESULTS: A total of 16 falls involving 13 patients were recorded by depth sensors. Six of the 13 patients who fell were classified as high risk on the basis of the hospital's fall rating tool. Common contributing factors included difficulty rising from their bed, weakened lower extremities, and unsteady or slow gait. Eleven of the falls involved patients reaching for objects in their path in an effort to achieve stability. Nurses had less than two minutes from the time a patient began to exit a bed to the time a fall occurred. Patients expressed few complaints with depth sensors installed in rooms. CONCLUSION: Fall-detection sensor systems offer valuable data for analyzing the nature of patient falls, with the potential promise of prescribing specific fall interventions for patients and to identify staff development opportunities. Hospitals should understand these devices' benefits and limitations and how they affect nursing practice.