Encyclopedia

Fall Rates

<p><span style="font-size: small;"><strong><u>Fall rates</u> </strong>are based on staff-reported incidents and calculated as the number of patient falls divided by the number of patient days multiplied by 1000. </span></p> <ul> <li><span style="font-size: small;">Total # of patient falls / Total # of patient days x1000 patient day </span></li> </ul> <p><span style="font-size: small;">The total number of patient days refers to what the Joint Commission calls &ldquo;bed days of care&rdquo; (2005). BDOC indicates how many days care recipients were occupying beds. For example if a unit has a census of 30 for 30 days, this is equivalent to 900 BDOC. If this same unit had 4 falls in the last 30 days, the fall rate would be (4/900) x 1000 = 4.44 falls per 1000 patient days. Acute care hospitals&rsquo; fall rates average 3.73 per 1,000 patient days, though fall rates vary based on unit type (Dunton, Gajewski, Taunton, &amp; Moore, 2004). </span></p> <p><span style="font-size: small;"><strong><u>Fall injury rates</u></strong></span><em><span style="font-size: small;"> </span></em><span style="font-size: small;">are calculated in two different ways. One measures how many injuries occurred per 100 falls. This is calculated as the number of injuries due to falls divided by the number of falls multiplied by 100. </span></p> <ul> <li><span style="font-size: small;">Total # of fall injuries / Total # of falls x 100 fall </span></li> </ul> <p><span style="font-size: small;">Alternatively, fall injury rates are measured as the number of injuries due to falls per 1000 patient days. This is calculated as the number of fall injuries divided by the number of patient days multiplied by 1000. </span></p> <ul> <li><span style="font-size: small;">Total # of fall injuries / Total # of patient days x 1000 patient days </span></li> </ul> <p><span style="font-size: small;"><strong><u>Definitions of injuries:</u> </strong>The NDNQI established standard definitions for injuries classified by severity (2005).<br /> </span></p> <ul> <li><span style="font-size: small;">None: a fall that results in no injury. </span></li> <li><span style="font-size: small;">Minor: a fall-related injury that results in the application of a dressing or ice, cleaning of a wound, limb elevation, or topical medication use. </span></li> <li><span style="font-size: small;">Moderate: a fall-related injury that results in suturing, steri-strips/skin glue application, or splinting. </span></li> <li><span style="font-size: small;">Major: a fall-related injury that results in surgery, casting, or traction, or requires consultation for neurological or internal injury. </span></li> <li><span style="font-size: small;">Death that is determined to result from a fall. </span></li> </ul> <p><span style="font-size: small;"><strong><u>Using fall measures:</u> </strong>The Hartford Institute (ConsultGeriRN.org) recommends the following uses of fall measures and monitoring:<br /> </span></p> <ul> <li><span style="font-size: small;">Monitor fall incidence and incidences of patient injury due to a fall, comparing rates on the same unit over time. </span></li> <li><span style="font-size: small;">Compare falls per patient month against national benchmarks available in the National Database of Nursing Quality Indicators. </span></li> <li><span style="font-size: small;">Incorporate continuous quality improvement criteria into falls prevention program.</span></li> </ul> <p><span style="color: #D85F28;"><span style="font-size: larger;"><u><b>Links</b></u></span></span></p> <p><span style="font-size: small;"> </span></p> <ul> <li><span style="font-size: small;">Hartford Institute for Geriatric Nursing</span>: <span style="font-size: small;">ConsultGeriRN.org - &ldquo;Falls: Nursing Standard of Practice Protocol&rdquo;<br /> </span><a rel="nofollow" title="http://www.consultgerirn.org/topics/falls/want_to_know_more" class="external free" href="http://www.consultgerirn.org/topics/falls/want_to_know_more"><span style="font-size: small;">http://www.consultgerirn.org/topics/falls/want_to_know_more</span></a></li> </ul> <p><span style="color: #D85F28;"><span style="font-size: larger;"><u><b>References</b></u></span></span></p> <ul> <li><span style="font-size: small;">Dunton, N., Gajewski, B., Taunton, R. L., &amp; Moore, J. (2004). Nurse staffing and patient falls on acute care hospital units. Nursing Outlook, 52(1), 53-59. </span></li> <li><span style="font-size: small;">Krauss, M. J., Nguyen, S. L., Dunagan, W. C., et al. (2007). Circumstances of patient falls and injuries in nine hospitals in a Midwestern healthcare system. Infection Control and Hospital Epidemiology 28(5), 544-550. </span></li> <li><span style="font-size: small;">Joint Commission on Accreditation of Healthcare Organizations (JCAHO). (2006). Patient falls (NPC-3) and patient falls with injury (NCS-4). Implementation guide for the NQF-endorsed nursing sensitive care performance measures 2005 (No. Version 1.00). Oakbrook Terrace, IL: Author. </span></li> <li><span style="font-size: small;">Joint Commission Resources. (2005). Reducing the risk of falls in your health care organization. I. J. Smith (ed.). Oakbrook Terrace, IL: Author. </span></li> <li><span style="font-size: small;">National Database of Nursing Quality Indicators (NDNQI). (2005). Guidelines for data collection and submission on quarterly indicators. Kansas City, MO: American Nurses Association. </span></li> <li><span style="font-size: small;">Wagner, L. M., Capezuti, E., Clark, P. C., Parmelee, P. A. &amp; Ouslander, J. G. (2008). Use of a falls incident reporting system to improve care process documentation in nursing homes. Quality and Safety in Health Care, 17(2), 104-108. </span></li> <li><span style="font-size: small;">Wagner, L. M., Capezuti, E., Taylor, J. A., Sattin, R. W. &amp; Ouslander, J. G. (2005). Impact of a falls menu-driven incident-reporting system on documentation and quality improvement in nursing homes. Gerontologist 45(6), 835-842. </span></li> </ul>