Effect of a multidisciplinary fall risk assessment on falls among neurology inpatients

OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit.PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention.RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not.CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls.Falls are the most common adverse event reported in acute care settings.^1,2 They prolong hospitalization, increase cost of care, and have the potential to cause serious injury.³ Multiple risk factors for falls have been identified: advanced age, muscle weakness, gait or balance problems, visual impairment, altered bowel or bladder elimination patterns, dizziness or vertigo, depression, cognitive deficits, impaired activities of daily living, use of psychotropic medications, and a history of falls.^1,4-7 These risk factors are common among patients with neurologic disease. For this reason, several specific neurologic conditions, such as stroke, dementia, Parkinson disease, and peripheral neuropathy, confer an increased risk for falls,⁸ and neurology inpatient units have among the highest rates of falls.⁹Among hospitalized patients, rates of falls range from 1.97 to 8.40 falls per 1000 patient-days.^9-13 The rate of falls on our neurology inpatient unit was 5.69 falls per 1000 patient-days during 2006 and 2007. The objective of this study was to evaluate whether the addition of a physician fall risk assessment to the existing nurse fall risk assessment process was feasible and whether it would lead to a reduction in our inpatient rate of falls. Our hypothesis was that adding a physician assessment would increase the number of neurology inpatients identified as at risk for falls, leading to more patients receiving fall prevention measures and, ultimately, a reduction in rate of falls.