Factors Associated with Inpatient Falls and Injurious Falls in Acute Care Hospitals

Abstract

Inpatient falls and injurious falls in acute care settings have significant impact on patients. Despite the implementation of several federal initiatives in preventing falls and injurious falls, inpatient falls and injurious falls still are prevalent in the United States. Inpatient falls and injurious falls are a complicated phenomenon and can be contributed to multilevel factors including organization at the hospital and unit levels, nursing care process, and patient-specific factors. However, gaps exist in the literature on the associations of injurious falls with multilevel factors. The purpose of this study was to examine the associations of injurious falls in acute care hospitals with multilevel factors including hospital and unit structure, nursing care process, and patient-specific factors. The modified Donabedian Structure–Process–Outcome (SPO) model was used as a conceptual framework to guide the study. This cross-sectional, correlational study used July 2013 to June 2014 data from the National Database of Nursing Quality Indicators® (NDNQI®). The STATA (Version 14) was used to conduct hierarchical regression analyses to examine the significance of association of injurious falls with multilevel factors including organizational structure (i.e., hospital size, teaching status, and Magnet® status), unit structure (i.e., nurse staffing and unit type), nursing care process (i.e., falls without employee assistance, fall risk assessment, implementation of fall prevention protocol, and physical restrain use) and unit patient population factors for patients who fell (i.e., gender, and fall risk status). The results of the study suggested hospital structure (i.e. teaching status), unit structure (i.e. surgical unit and RN hours per patient day), unit nursing care process (i.e. falls without employee assistance), unit patient population characteristics (i.e. at fall risk) and 1000 patient days were significantly associated with incidence of injurious falls. The findings from this study provide further knowledge on multilevel factors contributing to inpatient injurious falls. Nurse leaders, researchers and policy makers may develop, implement and improve fall prevention programs based on the identified risk factors. The study also provides important implications for future research on injurious fall prevention in acute care hospitals.