|Dr Harry Harianto
Monash Health, Australia
Falls: The Visibility and The Distance from Nursing Station
evidence suggests a possible benefit in patients placed visible from and closed
to nursing station in in-hospital falls prevention. However, the associations
between the incidence of in-hospital falls and visibility and distance from
nursing station have not been adequately investigated.
Objectives: To describe
the prevalence of in-hospital falls according to the visibility and the
distance from nursing station.
Methods: A preliminary
results of retrospective audit study of patients with an incident in-hospital
fall during admissions under a General Internal Medicine Unit over thirteen
month period are presented. The relevant data were collected by review of
medical records. In-hospital falls were
identified from the Victorian Health Incident Management System (VHIMS) data
base. The data on falls characteristics and circumstances were collected from
the hospital data base that was set up as part of the falls prevention
Results: A total of 126
patients had in-hospital falls (145 falls) during the study period with mean
age of 76.7 + 14.84 years. Of these, 16 (12.7%) patients had recurrent
in-hospital falls (> 2 falls in the same admission). The in-hospital fallers
were predominantly male (57.9%) and from home (59.5%). The incidence of falls
in the hospital was highest (47.6%) overnight. Most in-hospital falls occurred
in patients situated in beds with no visibility (70.3%) and distance of more
than 10 metres (63.4%) from nursing station, and multiple occupancy room
(54.4%). Interestingly, when compared with single falls, the occurrence of
recurrent falls was significantly higher in bed locations directly visible
(34.3% cf. 18.2%, P=0.046) but significantly lower in bed locations furthest
(45.7% cf. 69.1%, P=0.013) from nursing station.
Conclusion: The incidence of in-hospital falls was high among patients not
visible and further from nursing station. Interestingly, the recurrent falls
occurs significantly more frequent in bed locations visible to nursing station
but less in distant bed locations. However, this needs to be further
investigated in case controlled and longitudinal studies.
In-hospital Falls: The Risk Factors
and The Role of Hyponatraemia
suggests a possible causal association between hyponatraemia and falls.
However, this has not been adequately investigated in the context of
in-hospital falls (IHFs).
To characterise the
potential risk factors for IHFs in older people, particularly the role of
Methods: A case control study of patients aged >65 years with an
incident in-hospital fall during admissions under a General Internal Medicine
Unit over a six month period was conducted. The relevant data were collected by
review of medical records and analysed in univariate and multivariate models.
Results: The prevalence of IHF was 7.2%. Hyponatraemia had a
significant univariate association with IHF (P=0.005). This association
remained significant even after controlling for covariates (adjusted odds ratio
(OR) 1.890, 95% confidence interval (CI) 1.391-3.497, P=0.021). The frequency
of IHF was similar regardless of the severity of hyponatraemia (P=0.267). The
other variables that had an independent association with IHFs were admission
falls (OR 1.570, CI 1.340-5.833, P=0.030), use of psychotropic medications (OR=4.440, CI 2.051-13.240,
diuretics (OR=0.827, CI 0.767-0.901, P=0.010), and cardiovascular diagnosis
(OR=0.916, CI 0.893-0.942, P=0.039).
Conclusions: Hyponatraemia is independently associated
with increased risk of IHFs. Other potential risk factors for IHFs include admission falls and psychotropic medication use. Diuretic use and cardiovascular diagnosis
have a significant inverse association with IHFs.