In-patient falls: what can we learn from incident reports?

Background: a previous analysis of 12 months data from the National Reporting and Learning System offered useful insights on contributory factors for patient falls but was limited due to the small data set of free-text analysis (n = 400). A subsequent pilot study of 4,571 reports found an apparent difference in the contributory factors for patients described as having cognitive and physical impairments. Objective: to analyse 3 years national incident data (2005-08) to further explore the contributory factors of in-patient falls. Methods: a total of 20,036 reports (15% sample) were analysed by coding the free-text data field. Contributory risk factors were compared with the whole sample and explored with the Chi-squared and Fisher's exact tests. Results: data were reported about the degree of harm (100% of reports), (un)witnessed status of fall (78%), location (47%), patient activity (27%), physical impairment/frailty (9.5%) and cognitive impairment/confusion (9.2%). Less than 0.1% of reports provided data about dizziness, illness, vision/hearing, and medicines. Overall, patients were more likely to be harmed when away from the bed space, mobilising/walking and by falling from the bed when not intending to leave the bed. Conclusions: this analysis explored incident reports at a level of detail not previously achieved. It identifies significant contributory factors for fall locations and activities associated with physical and cognitive characteristics.