Dr Harry Harianto
Monash Health, Australia 


In-hospital Falls: The Visibility and The Distance from Nursing Station
Harry Harianto

Background: Recent 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 initiative.

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

Background: Recent evidence suggests a possible causal association between hyponatraemia and falls. However, this has not been adequately investigated in the context of in-hospital falls (IHFs).

Objectives: To characterise the potential risk factors for IHFs in older people, particularly the role of hyponatraemia.

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, P<0.001) and 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.