Fall rates are based on staff-reported incidents and calculated as the number of patient falls divided by the number of patient days multiplied by 1000.
- Total # of patient falls / Total # of patient days x1000 patient day
The total number of patient days refers to what the Joint Commission calls “bed days of care” (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’ fall rates average 3.73 per 1,000 patient days, though fall rates vary based on unit type (Dunton, Gajewski, Taunton, & Moore, 2004).
Fall injury rates 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.
- Total # of fall injuries / Total # of falls x 100 fall
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.
- Total # of fall injuries / Total # of patient days x 1000 patient days
Definitions of injuries: The NDNQI established standard definitions for injuries classified by severity (2005).
- None: a fall that results in no injury.
- 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.
- Moderate: a fall-related injury that results in suturing, steri-strips/skin glue application, or splinting.
- Major: a fall-related injury that results in surgery, casting, or traction, or requires consultation for neurological or internal injury.
- Death that is determined to result from a fall.
Using fall measures: The Hartford Institute (ConsultGeriRN.org) recommends the following uses of fall measures and monitoring:
- Monitor fall incidence and incidences of patient injury due to a fall, comparing rates on the same unit over time.
- Compare falls per patient month against national benchmarks available in the National Database of Nursing Quality Indicators.
- Incorporate continuous quality improvement criteria into falls prevention program.
- Dunton, N., Gajewski, B., Taunton, R. L., & Moore, J. (2004). Nurse staffing and patient falls on acute care hospital units. Nursing Outlook, 52(1), 53-59.
- 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.
- 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.
- Joint Commission Resources. (2005). Reducing the risk of falls in your health care organization. I. J. Smith (ed.). Oakbrook Terrace, IL: Author.
- National Database of Nursing Quality Indicators (NDNQI). (2005). Guidelines for data collection and submission on quarterly indicators. Kansas City, MO: American Nurses Association.
- Wagner, L. M., Capezuti, E., Clark, P. C., Parmelee, P. A. & 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.
- Wagner, L. M., Capezuti, E., Taylor, J. A., Sattin, R. W. & 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.