PATIENTS WHO FALL IN HOSPITAL —
CONTRIBUTING FACTORS
M I BRIGHT (Senior Sister), L M MINNY (Senior Tutor)
G M RATSEY (Senior Sister), S W RAWSTORNE (Senior Sister)
Advancement of Study
OPSOMMING
Die faktore wat bydra tot beserings by pasiënte wat val is bestudeer. Hiervoor is die verslae oor insidente waarin pasiente in ’n Blanke provinsiale
hospitaal tussen 1 Januarie en 30 Junie 1982 geval het, ontleed.
Aan die hand van bevindings maak die navorsers aanbevelings oor wanneer en by watter tipe pasiënte verpleegkundiges meer waaksaam moet
wees. Hulle beveel ook aan dat meer besonderhede oor insidente in die ver­
slae aangeteken moet word.
INTRODUCTION
T his is a retro sp ectiv e study o f the
facto rs w hich c o n trib u te d to acci­
d en tal in ju ries su stain ed by those
p a tie n ts w ho fell in a W h ite p ro v in ­
cial h o sp ital in die p e rio d 1 Ja n u a ry
to 30 Ju n e 1982.
T h e re se a rc h stu d y w as u n d e r­
ta k e n by D ip lo m a in N ursing
A d m in is tra tio n s tu d e n ts d u r i ng
th e ir 3-w eek h o sp ital p ractica a t a
W hite provincial hosp ital.
RESEARCH DESIGN
Problem
In o rd e r to re d u c e th e in cidence o f
falls (an d c o n se q u e n t accid en tal in­
ju ries) th o se facto rs w hich c o n tri­
bu te to falls m ust be id en tified .
Objectives
• T o d e te rm in e th e n u m b e r o f fall­
ing incid en ts involving p a tie n ts
w ho w ere in th e h o sp ital b etw een
1 Ja n u a ry a n d 30 Ju n e 1982.
• T o identify any specific area(s)
w ithin th e h o sp ital w hich m ay be
co n sid ered as higher-risk areas.
• T o classify th e types o f p a tie n ts
w ho fell.
• T o d e te rm in e th e age-groups of
th o se p a tie n ts w ho fell to identify
high-risk age-groups.
• T o d e te rm in e th e ra tio o f falls
w ith re g a rd to day an d night
duty.
• T o draw co nclusions an d m ak e
52
any re co m m e n d atio n s if necess­
ary.
Definition of Criteria
Patients — any p e rso n s in ho sp ital
fo r th e p u rp o se o f m edical tre a t­
m en t.
Accidental Injury — any non-inte n tio n al im p a irm e n t, h arm o r h u rt
e x p erien ced by a p a tie n t as the
resu lt o f a fall.
Fall — the situ a tio n w h ereb y the
p a tie n t e ith e r ceases to stan d o r b e ­
comes prostrate and actually
reaches th e floor.
Hospital — fo r th e p u rp o se o f this
study re fers to th e W h ite provincial
hosp ital w h ere th e stu d y w as u n d e r­
ta k e n .
Collection of Data
S ta te m e n t form s (w ritte n by n u rs­
ing staff and k e p t by th e m a tro n 's
office) will be p e ru sed to identify
th e p a tie n ts w ho fell in th e h o spital
durin g th e p e rio d m e n tio n e d an d to
ex tract th e rele v an t in fo rm atio n .
R e lev an t lite ra tu re will be o b ­
ta in e d from th e h o spital lib rarian .
Time Barriers
— co m p letio n o f p eru sal o f s ta te ­
m en t form s 12.7.82
— co m pilation o f co m p arativ e and
q u an titiv e c h arts 19.7.82
— i n t e r p r e t a t i o n of charts
20.7.82
— co m p letio n o f p ro je c t 23.7.82
CURATIONIS
Significant re c o m m e n d a tio n s will
be m ade an d th e c o m p lete study
h a n d e d in to the C h ie f M a tro n of
th e hospital.
COMMENTS ON THE DATA
COLLECTION
T he policy o f th e h o sp ital co n ­
ce rn ed re q u ire s th a t th e d etails of
each in cid en t w hich involves a
p a tie n t falling a re re c o rd e d a n d re ­
p o rte d in d u p lica te o n a p rescrib ed
sta te m e n t form .
T h ese sta te m e n ts a re co m p leted
by the nursing p e rso n n el. T h e nurse
in charge o f th e w ard at th e tim e of
th e in cid en t an d th e n u rse w h o saw ,
h e a rd o f o r w ho w as involved in the
in cid en t, b o th sign this sta te m e n t.
T he p a tie n t’s d o c to r is n o tified and
is re q u ire d to e n d o rse th e sta te m e n t
as so o n as p o ssible a fte r th e inci­
d en t.
T he copy o f th e sta te m e n t is filed
w ith th e p a tie n t’s case -sh e et. T he
original is su b m itted to th e m atro n
o f th e h o spital fo r n o tin g , possible
co m m en t an d filing.
F o r th e p u rp o se o f this study it
was assum ed th a t ev ery incident
was in fact re p o rte d in this m an n er.
A ll th e sta te m e n t form s fo r the
p e rio d m e n tio n e d w ere p e ru se d and
th o se th a t did n o t p e rta in to inci­
den ts in w hich a p a tie n t h ad fallen
w ere e lim in ated .
Fifty fo u r sta te m e n ts w ere ex­
tra c te d an d th e follow ing in fo rm a­
tion was n o te d from each:
• th e p a tie n t’s nam e
• the p a tie n t’s reg iste red n u m b e r
• the p a tie n t’s age
• th e m edical diagnosis
• the w ard in w hich th e p a tie n t fell
• the tim e o f th e incident
• d etails as re c o rd e d by th e nursing
p erso n n el
• in ju ries su stain ed (if a n y ) by the
p a tien t.
VOL.6 NO. 1
T he h o sp ital lib ra ria n w as asked
to o b ta in any re le v an t lite ra tu re
p e rtain in g to p a tie n t in ju ries in a
h ospital, an d a fte r sev eral h o u rs of
searching m an ag ed to find only tw o
references:
C h ip m an , C: W h at d o es it m ean
w hen a p a tie n t falls? P A R T 1: P in ­
pointing th e cause. Geriatrics 36(9)
S ept. 1981 p. 83-95.
M orris, E V: T h e p re v e n tio n of
falls in a g eriatric h o sp ital. A g e
A g ein g 10(23) A u g . 1981 p. 165168.
U n fo rtu n a te ly it w as n o t possible
to refe r to th ese articles in this study
because tim e did n o t p e rm it th em
being o b ta in e d . T h e fact th a t very
little d o c u m e n ta tio n existed only
serv ed to p ro v id e a g re a te r chal­
lenge.
It is also u n fo rtu n a te th a t th e
case-sheets o f th o se p a tie n ts in ­
volved w ere n o t p e ru se d . A ny im ­
p o rta n t p re-d isp o sin g facto rs are
n o t know n a n d can only be p re ­
sum ed to be o f som e significance.
T his includes facto rs such as:
— m ed icatio n
— nigh t sed atio n
— p o st-a n a e sth e tic
physiological
instability
— tim e o f in cid en t in re la tio n to
any p ro c e d u re being p e rfo rm e d .
T he conclusions d raw n an d the
reco m m e n d a tio n s m ad e in this
study a re b ased only o n th e in fo r­
m atio n o b ta in e d fro m th e sta te m e n t
form s.
FINDINGS
• A to ta l o f 54 p a tie n ts fell in th e
hospital d u rin g th e p erio d 1 Ja n u a ry
to 30 Ju n e 1982. T h ese can be su b ­
divided as follow s:
26 fell o u t o f b e d o r w hile try in g to
get o u t o f b ed (48,2 % )
10 slipped (18,5 % )
8 fell w hile trying to stan d u p from
th e co m m o d e (14,8 % )
6 fell w hile trying to sta n d u p from
a ch air (11,1 % )
4 collap sed w hile stan d in g or
w alking (7 ,4 % )
• 18 m ale m edical p a tie n ts fell
(33,3 % )
15 fem ale surgical p a tie n ts fell
(27,8 % )
13 fem ale m ed ical p a tie n ts fell
(24,1 % )
8 m a l e s u r g i c a l p a t i e n t s fell
(14,8 % ) (see also figure 1)
MAART 1983
FIGURE 1: GRAPH ILLUSTRAT­
ING THE INCIDENCE OF FALLS
ACCORDING TO SEX AND TYPE
OF PATIENTS W HO FELL IN A
WHITE PROVINCIAL HOSPITAL
IN THE PERIOD 1 JANUARY 1982
TO 30 JUNE 1982.
• T h e n u m b e r o f falls on day duty
and night d u ty w ere as follow s (see
also figure 3):
34 fell b etw een 19h00 - 07h00
(night duty) 62,9 %
20 fell b etw een 07h00 - 19h00 (day
duty) 37,1 %
• T h e injuries su stain ed included
— a fra c tu re d leg in o n e p a tie n t,
— laceratio n s,
— contusions,
— ab rasio n s,
— slight localised sw elling,
— sm all cuts n o t req u irin g su tu r­
ing.
FIGURE 3: GRAPH ILLUSTRAT­
ING THE TIM E OF DAY AT
W HICH PATIENTS FELL IN A
W HITE PROVINCIAL HOSPITAL
IN THE PERIOD 1 JANUARY 1982
TO 30 JUNE 1982
• T h e follow ing in fo rm a tio n was
e x tra c te d reg ard in g th e age groups
o f p a tie n ts w ho fell (see also figure
2 ):
80-89
70-79
20-29
50-59
60-69
40-49
0- 9
30-39
10-19
90-99
years
y ears
y ears
y ears
y ears
y ears
years
years
y ears
years
13
10
7 in each
group
I
J
\
/
PATIENTS
WHO
FELL
4
2 in each
gro u p
1 in each
g ro u p
FIGURE 2: GRAPH ILLUSTRAT­
ING THE INCIDENCE OF FALLS
ACCORDING TO THE AGE OF
PATIENTS W HO FELL IN A
W HITE PROVINCIAL HOSPITAL
IN THE PERIOD 1 JANUARY 1982
TO 30 JUNE 1982.
PATIENTS
WHO
•
—
—
—
After effects included
head ach e
shock
confusion in o n e p a tie n t.
T h irty -th ree p a tie n ts su ffered no
ill-effects o r did n o t sustain any in­
juries at all.
• T he m edical diagnoses did not
a p p e a r to be o f any co n trib u to ry
significance, th e only diagnoses
w o rth noting being:
— d iab ete s in fo u r p a tie n ts
— cereb ro -v ascu lar accident in five
p a tie n ts.
FELL
AOE GROUPS
CURATIONIS
• T h e re is a low o ccu rren ce of
p atien ts falling in w ards th a t consist
of single ro o m s c o m p ared to the
general w ards.
• T h e sta te m e n t form s did n o t
alw ays give en o u g h in fo rm a tio n re-
53
garding th e p red isp o sin g causes or
factors w hich m ay have c o n trib u te d
to th e p a tie n ts’ falls, fo r exam ple
— n i g h t s e d a t i o n s / m e d i c a ti o n s
given w ere n o t m e n tio n e d
— p o st-o p e ra tiv e day w as n o t in ­
cluded in surgical cases
— all staff o n duty at th e tim e of
th e in cid en t w ere n o t a d e q u a te ­
ly a c c o u n te r fo r
— th e m en tal sta te o f p a tie n ts was
n o t m e n tio n ed .
RECOMMENDATIONS AND
CONCLUSIONS
• In creased vigilance an d su p erv i­
sion m ust be im p le m e n te d in th e
follow ing instances:
— m ale m edical p a tie n ts
— fem ale m edical p a tie n ts
54
— p a tie n ts in th e age-groups 20-29
years, above 50 years o f age and
especially ab ove 70 years.
— o n night d u ty (seven falls above
th e average o f 27).
• N ursing p e rso n n el m u st be aw are
of th e v u ln erability o f th e follow ing:
— p a tie n ts w ho a re getting o u t of
b e d fo r th e first tim e follow ing a
long p e rio d o f lying in b e d o r an
an aesth etic
— p a tie n ts w ho are being ta u g h t to
w alk on cru tch es
— p a tie n ts w ho have b e en given a
sed ative and w ho get up to go to
th e to ilet d u rin g th e night and
early in th e m orning
— p a tie n ts w ho w ea r bedsocks.
• C o tsides m u st b e e re c te d on the
CURATIONIS
b e d o f any p a tie n t w ho is d iso rien ­
ta te d and confused. W h e re a b so lu ­
tely necessary a larg e, soft covering
n e t could be used o v e r th e cotside.
• S ta tem en ts m u st be m o re d e ­
tailed as it w as difficult to ascertain
by th e in fo rm atio n given in som e in­
stances how th e p a tie n t cam e to be
on the floor.
ACKNOWLEDGEMENTS
The participants in this study would like to
express their gratitude to the Chief Nursing
Officer of Natal, the Deputy Chief Nursing
Officer and the Chief Matron of the hospital
where the study was undertaken. Without
their enthusiasm and support, this expe­
rience would never have been possible.
VOL.6 NO. 1