"Patient education should be a priority," says Melissa J. Krauss, research coordinator in infectious diseases, who helped conduct the study as part of a continuing Washington University Medical Center effort to reduce accidents and improve patient care. "Patients need to be reminded that they're on a number of medications, in an unfamiliar environment, and being put through a routine of tests, procedures and bed rest, all of which can make them weaker and more susceptible to falling."
Other recommendations include ensuring assistive devices like canes and walkers are available in hospital rooms for patients who normally use such devices. Krauss also recommends expanded use of regularly scheduled, assisted trips to the bathroom for patients at high risk of falling.
The lead investigator for the study, which will be published in the June 16 Journal of General Internal Medicine, is Victoria J. Fraser, M.D., professor of medicine and co-director of the Division of Infectious Diseases at Washington University and Barnes-Jewish Hospital.
Frasier, Krauss and their colleagues analyzed 200 patient falls that occurred over a 13-week period at Barnes-Jewish Hospital. Researchers interviewed patients, nurses and family members after falls and gathered information from reports and records kept by nurses.
Patients were injured in 42 percent of the falls. Some falls led to minor injuries such as cuts, scrapes or bruises, and about 8 percent of the incidents caused serious injuries such as head traumas or fractures.
"When we compared people who did not sustain an injury to those who did, we found that patients who were involved in an elimination fall -- a fall related to the need to use the toilet -- were more likely to sustain an injury," Krauss says.
Elimination falls do not necessarily occur in the bathroom, Krauss notes. They can occur in the bathroom, on the way from the bed to the bathroom or on bedside commodes, portable toilets placed next to patients' beds. Patients who fell while using a bedside commode were at a particularly high risk of serious injury.
Krauss suggests that nurses and family members might establish a regular schedule of assisted trips to the bathroom for patients at high risk of falling. This practice is already in use in some hospitals, but it could be expanded and more aggressively enforced for high-risk patients, according to Krauss.
Researchers also found that patients who would normally use a walker or a cane outside the hospital frequently weren't using one when they fell.
Krauss notes that many other challenges to preventing patient falls remain, including working with patients whose judgements may be affected by their conditions or treatments, potentially rendering them too confused or unlikely to remember that they should not try to get out of bed on their own.
Krauss and her colleagues are currently taking a closer look at risk factors for falling in a follow-up case-control study.
Hitcho EB, Krauss MJ, Birge S, Dugan WC, Fischer I, Johnson S, Nast PA, Costantinou E, Fraser VJ. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. Journal of General Internal Medicine, June 16, 2004.
Funding from the Agency for Healthcare Research and Quality.
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Journal
Journal of General Internal Medicine