Falls on integrated medical wards

Abstract

Background: An effective approach to fall prevention should involve an assessment of environmental as well as patient-related characteristics.

Objective: To study the effect of age and ward design on fall characteristics among medical inpatients.

Methods: In a prospective open observational study over 1 year, we studied falls on three medical wards. Wards A and B are nuclear designed, and C is longitudinal.

Results: We recorded 199 falls involving 167 fallers. Fifty-four (27.1%) involved patients under 65 years. Most falls were intrinsic (60.8%) and involved elderly male patients (male/female ratio 97/48 vs. 24/30; p = 0.009). We identified no age differences in relation to location, activity, preceding fall, classification, time, consequences, and intervention required. On ward C, most falls occurred in the bed areas (bays and cubicles), but on wards A and B a higher proportion occurred in bathroom, corridor, and dayroom (C vs. A/B 87.9 vs. 73.7/62.0%; p = 0.04/p = 0.004). On ward C, activities of daily living around the bed significantly preceded falls (C vs. A/B 44.6 vs. 25.9/24.1%; p = 0.03/p = 0.01). Most falls were unwitnessed (C vs. A/B 10 vs. 21/20; p = 0.002/p = 0.0009).

Conclusions: Intrinsic falls are the commonest; however, differences exist in fall demographics between wards, and this must be recognized to enhance the effectiveness of fall prevention programmes.