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Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?

Dykes, Patricia C. DNSc, RN; Carroll, Diane L. PhD, RN, APRN, FAAN; Hurley, Ann C. DNSc, RN, FAAN; Benoit, Angela BS; Middleton, Blackford MD, MPH, MSc

Journal of Nursing Administration: June 2009 - Volume 39 - Issue 6 - p 299-304
doi: 10.1097/NNA.0b013e3181a7788a

Objective: Obtain the views of nurses and assistants as to why patients in acute care hospitals fall.

Background: Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals.

Methods: Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for analysis.

Results: Positive and negative components of 6 concepts-patient report, information access, signage, environment, teamwork, and involving patient/family-formed 2 core categories: knowledge/ communication and capability/actions that are facilitators or barriers, respectively, to preventing falls.

Conclusion: Two conditions are required to reduce patient falls. A patient care plan including current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Second, stakeholders must use that information plus their own knowledge and skills and patient and hospital resources to carry out the plan.

Authors' Affiliations: Corporate Manager (Dr Dykes), Nursing Informatics & Research, and Applications Analyst II (Ms Benoit), and Corporate Director (Dr Middleton), Clinical Informatics Research & Development, Partners HealthCare, Wellesley, Massachusetts; Department of General Medicine (Drs Dykes and Middleton), Senior Nurse Scientist-Emerita (Dr Hurley), Center for Nursing Excellence, Brigham and Women's Hospital, Boston, Massachusetts; Instructor in Medicine (Dr Dykes), Associate Professor (Dr Middleton), Harvard Medical School, Boston, Massachusetts; Yvonne L. Munn Nurse Researcher (Dr Carroll), Yvonne L. Munn Center for Nursing Research, Institute for Patient Care, Massachusetts General Hospital, Boston; and Adjunct Professor of Nursing (Drs Carroll and Hurley), School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.

Corresponding author: Dr Dykes, Nursing Informatics & Research, Clinical Informatics Research & Development, Partners HealthCare, 93 Worcester St, Wellesley, MA 02481 (

© 2009 Lippincott Williams & Wilkins, Inc.