Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape

[摘要] ENGLISH SUMMARY : Background:The fall rate of patients in hospital settings is a worldwide concern due to the impact falls have on an individual patient, the family or relatives, as well as the healthcare setting. Hospitalised patients have a 12% chance of falling whilst in hospital. Factors involved in patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix. Patient fall risk assessments are important measures to prevent falls or minimise the impact thereof.The aim of this study was to determine the factors that influence patient falls in a private hospital group in the Cape Metropole of the Western Cape. The objectives were to determine the intrinsic and extrinsic factors that contributed to patient falls, to classify the severity of the injuries sustained during patient falls and to determine whether a lack of fall risk assessment by nurses contributed to patient falls.Methods: A quantitative retrospective descriptive research approach was used. A total of 134 records of patients that have fallen over the timeframe from October 2016–February 2018 were included in the study. Patient documentation and all other relevant information related to the falls were utilised. The data was collected by means of a data extraction sheet and all information was anonymised at the point of collection. The Health Research Ethics Committee (HREC) of the University of Stellenbosch granted a waiver of informed consent. The data was analysed using the SPSS package.Results: The intrinsic factors that contributed to patient falls were identified as the patient's age, being hypertensive, co-morbidities and the use of benzodiazepines as a sedative.The extrinsic factors were the incorrect use of the bed rails and the skill mix of the staff. In just over half of the cases (n=68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of a more severe fall increased 2.4 times with the lack of risk assessment.Conclusion: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals. Recommendations include the revision of risk assessment tools to incorporate context-specific factors, adherence to procedures regarding risk assessments as well as auditing the result of these assessments. Attention should be given to current skill mix ratios; an increase in the registered nurse category is proposed to align with international norms.

[发布机构] Stellenbosch University