Open AccessA Case‐control Study of Patient, Medication, and Care‐related Risk Factors for Inpatient Falls
Author(s) -
Krauss Melissa J.,
Evanoff Bradley,
Hitcho Eileen,
Ngugi Kinyungu E.,
Dunagan William Claiborne,
Fischer Irene,
Birge Stanley,
Johnson Shirley,
Costantinou Eileen,
Fraser Victoria J.
Publication year - 2005
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2005.40171.x
Subject(s) - medicine , odds ratio , confidence interval , medical record , emergency medicine , falling (accident) , case control study , fall prevention , poison control , injury prevention , environmental health
Objective: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls. Design: Case‐control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/or nurses and review of adverse event reports, medical records, and nurse staffing records. Setting: Large urban academic hospital. Patients: Ninety‐eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall. Measurements And Main Results: In a multivariate model of patient‐related, medication, and care‐related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient‐to‐nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of “up with assistance” compared with “bathroom privileges” (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024). Conclusions: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care‐related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling.