Patient Safety/Quality

Hospital fall prevention programs should target certain patient, medication, and care-related factors that increase falling risk

Falls account for up to 70 percent of accidents among hospitalized patients. A new study recently identified patient, medication, and care-related factors that increase the likelihood of falls. Patients most likely to fall suffered from gait and lower extremity problems or confusion, used certain medications (sedatives/hypnotics or diabetes medications), or needed assistance to get out of bed. Many falls occurred while an unassisted patient was walking or getting out of bed, usually to go to the bathroom, according to the study supported by the Agency for Healthcare Research and Quality (HS11898).

Hospital fall prevention programs should target patients with risk factors, monitor and adjust medication use related to falls, and consider scheduled mobilization and toileting to reduce falls, conclude the researchers who conducted the study. They used nurse and patient interviews and medical records to compare potential risk factors and circumstances of falls among 98 inpatients who fell and 318 matched controls who did not fall at the same hospital. Compared with controls, patients with gait/balance deficits or lower extremity problems were nine times as likely to fall, confused patients and those using sedatives/hypnotics were about four times as likely to fall, and those taking diabetes medications were three times as likely to fall.

Also, increasing the patient-to-nurse ratio nearly doubled the likelihood of a fall. Those who were only supposed to "get up with assistance" were much more likely than those with bathroom privileges to fall. Having one or more side rails raised was associated with a decreased risk of falling.

See "A case-control study of patient, medication, and care-related risk factors for inpatient falls," by Melissa J. Krauss, M.P.H., Bradley Evanoff, M.D., M.P.H., Eileen Hitcho, M.S., and others, in the February 2005 Journal of General Internal Medicine 20, pp. 116-122.

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