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Varpula J, Välimäki M, Pulkkinen J, Lantta T. Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care: A Sociotechnical Probabilistic Risk Modeling Study. J Nurs Care Qual 2023; 38:190-197. [PMID: 36476941 PMCID: PMC9944373 DOI: 10.1097/ncq.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient falls are a major adverse event in psychiatric inpatient care. PURPOSE To model the risk for patient falls in seclusion rooms in psychiatric inpatient care. METHODS Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis. RESULTS The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia. CONCLUSIONS Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Johanna Pulkkinen
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
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de Smet L, Carpels A, Creten L, De Pauw L, Van Eldere L, Desplenter F, De Hert M. Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital. Front Public Health 2022; 10:1020975. [PMID: 36388388 PMCID: PMC9651969 DOI: 10.3389/fpubh.2022.1020975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/13/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Falls in elderly patients treated in general hospitals have already been the focus of several studies. Research within psychiatric settings, however, remains limited, despite the fact that this population has a number of characteristics that could increase the fall risk. The aim of this retrospective study was to estimate the prevalence of falling in patients with a psychiatric hospital setting. Methods A retrospective descriptive chart review of falls registered in the period July 1, 2013 until June 30, 2019 in a Belgian University Psychiatric Hospital was conducted. Data were collected from the "patient related incident report and management system" (PiMS) of the hospital. All registered falls of all hospitalized patients were included in the study. Results During the 6-year study period an incidence of 4.4 falls per 1,000 patient days was found. Only 0.5% of the falls resulted in severe injury and none of these falls were fatal. Eighty percent of falls involved a patient over the age of 65. Only 25.0% of the elderly patients suffered physical consequences, while injuries were present in 31.4% of adults and 68.2% of young patients. The two most common causes of a fall were the health status (63.3%) and the behavior (55.1%) of the patient. Conclusion The estimated prevalence of falls in our study was generally in line with the rates found in literature on falls in psychiatric settings. Falls in psychiatric settings occur both in younger and older patients, suggesting that all age categories deserve sufficient attention in fall prevention policies. However, more research is necessary to improve fall prevention policies.
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Affiliation(s)
- Lynn de Smet
- University Psychiatric Center, KU Leuven, Leuven, Belgium,*Correspondence: Lynn de Smet
| | - Arnout Carpels
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Public Psychiatric Care Center Rekem, Rekem, Belgium
| | - Lotte Creten
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Louise De Pauw
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Franciska Desplenter
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc De Hert
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Center for Clinical Psychiatry, Department of Biomedical Sciences, KU Leuven, Leuven, Belgium,Antwerp Health Law and Ethics Chair, Universiteit Antwerpen, Antwerp, Belgium
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Cassola TP, Maidana Júnior JN, Pinho LBD, Schimid M, Suzuki LM, Severo IM. Análise das ocorrências de quedas associadas ao dano em unidade de internação psiquiátrica. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: analisar as ocorrências de quedas associadas ao dano em pacientes internados em uma unidade psiquiátrica. Método: estudo ecológico retrospectivo de 92 notificações de quedas em unidade de internação psiquiátrica. A coleta dos dados foram pelo sistema eletrônico GEO (Gestão Estratégica Operacional) do hospital estudado e do prontuário, sendo realizada estatística descritiva e testes não-paramétricos. Resultados: quanto ao grau de dano, 39,1% das quedas foram leves e 29,1% moderadas a graves, principalmente, em pacientes com Esquizofrenia e Transtorno Bipolar. As variáveis diagnóstico do paciente, tipo de queda, turno do evento, local da queda e eletroconvulsoterapia não mostraram associação com o grau de dano apresentado pelos pacientes após o evento. Conclusão: com o estudo, foi possível identificar as particularidades que afetam o paciente psiquiátrico e prever as condições mais prevalentes para o evento quedas, de modo a servir de subsídio para a instalação de medidas preventivas durante a internação.
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Turner K, Bjarnadottir R, Jo A, Repique RJR, Thomas J, Green JF, Staggs VS. Patient Falls and Injuries in U.S. Psychiatric Care: Incidence and Trends. Psychiatr Serv 2020; 71:899-905. [PMID: 32600184 DOI: 10.1176/appi.ps.202000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this study was to estimate the incidence of falls (total, injurious, and assisted) in U.S. psychiatric care across 6 years (April 2013-March 2019). METHODS Data on falls among patients of adult and geriatric psychiatric units of general, acute care, and psychiatric hospital inpatient units from the National Database of Nursing Quality Indicators were used for this 6-year study. Total falls, assisted falls (i.e., falls broken or slowed by staff), and injurious falls were calculated, along with trends in total and injurious fall rates. RESULTS The sample included 1,159 units in 720 hospitals. Of the 119,246 falls reported, 25,807 (21.6%) resulted in injury. Only 7.0% of the total falls in psychiatric units were assisted by a staff member. Falling unassisted was associated with a higher likelihood of fall-related injury (adjusted odds ratio=1.69, 95% confidence interval=1.59 to 1.80). The total fall rate (8.55 per 1,000 patient-days) and injurious fall rate (1.97 per 1,000 patient-days) were highest for geriatric psychiatric units in general hospitals. Total and injurious fall rates in psychiatric units in general hospitals declined during the study (total fall rate declined by 10% for adult psychiatric units in general hospitals). There was no clear trend in total or injurious fall rates for units in psychiatric hospitals. CONCLUSIONS Falls are a persistent problem in psychiatric care settings. Few fall-prevention programs have been tested in these settings, which have unique risk factors for falls. Additional research is needed to develop fall-prevention interventions in psychiatric care.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Ragnhildur Bjarnadottir
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Ara Jo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Renee John R Repique
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Jamie Thomas
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Jeanette F Green
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Vincent S Staggs
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
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Rao WW, Zeng LN, Zhang JW, Zong QQ, An FR, Ng CH, Ungvari GS, Yang FY, Zhang J, Peng KZ, Xiang YT. Worldwide prevalence of falls in older adults with psychiatric disorders: A meta-analysis of observational studies. Psychiatry Res 2019; 273:114-120. [PMID: 30641340 DOI: 10.1016/j.psychres.2018.12.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/05/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Falls are common in older adults with psychiatric disorders, but the epidemiological findings have been inconsistent. This meta-analysis examined the prevalence of falls in older psychiatric patients and its moderating factors. PubMed, EMBASE, Web of Science and PsycINFO databases were independently searched by three investigators from their inception date to Nov 31, 2017. The random effects meta-analysis was used to synthesize the prevalence of falls, while meta-regression and subgroup analyses were conducted to explore the moderating factors. Sixteen of the 2061 potentially relevant papers met the entry criteria for the meta-analysis. The pooled lifetime prevalence of falls was 17.25% (95% confidence interval: 13.14%-21.35%). Neither univariate and nor multivariate meta-regression analyses revealed any moderating effects of the study region, duration, sample size, and quality on the prevalence of falls (P values > 0.05). Falls in older adults with psychiatric disorders are common.
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Affiliation(s)
- Wen-Wang Rao
- Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Macao SAR, China
| | - Liang-Nan Zeng
- Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Macao SAR, China; Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University, Sichuan province, China
| | - Ji-Wen Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Qian-Qian Zong
- School of Nursing, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China.
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Fang-Yu Yang
- School of Nursing, Capital Medical University, Beijing, China
| | - Juan Zhang
- Faculty of Education, University of Macau, Macao SAR, China
| | - Kelly Z Peng
- Department of Business Administration, Hong Kong Shue Yan University, Hong Kong, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Macao SAR, China.
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