title: Narcotic administration and fall-related injury in the hospital: implications for patient safety programs and providers.
abstract: OBJECTIVE
  Identify factors that predict fall-related injury in hospitalized adults.
  
  
  METHODS
  Retrospective records review.
  
  
  METHODS
  435-bed university hospital.
  
  
  METHODS
  Inpatients with reported falls in 2010.
  
  
  RESULTS
  Medical records were available for 286/293 (98%) of reported falls in 251 patients. 25% (63/286) of falls were associated with injury, 4% (11/286) with serious injury. Compared to all fallers, patients with injury did not differ by gender or age. In univariate analysis, patients who reported hitting their head, had pre-fall confusion, or who received narcotics within 24 hours before falling were more likely to suffer injury (estimated odds ratios 6.04, 2.00 and 5.1, respectfully). In multivariate analysis, receiving a narcotic prior to falling was the strongest predictor of injury (estimated odds ratio 5.38; 95% confidence intervals 2.07-13.98, p < 0.001).
  
  
  CONCLUSIONS
  In this single-institution study, 25% of patients who fell suffered injury and 4% serious injury. Neither age nor gender predicted fall-related injury. Recent narcotic administration was the strongest predictor of injury. Strategies to prevent fall-related injury in the hospital should target patients receiving narcotics. When evaluating inpatients who have fallen, providers should be especially vigilant about injury in patients who have pre-fall confusion, hit their head, or have received recent narcotics.
authors.affiliation: Department of Internal Medicine, Division of Hospital Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
authors.forename: J Rush
authors.initials: JR
authors.lastname: Pierce
authors.forename: Michael
authors.initials: M
authors.lastname: Shirley
authors.forename: Emma F
authors.initials: EF
authors.lastname: Johnson
authors.forename: Huining
authors.initials: H
authors.lastname: Kang
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D008297:Male; D008499:Medical Records; D009294:Narcotics / Q000008:administration & dosage*; D009516:New Mexico; D061214:Patient Safety / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014947:Wounds and Injuries / Q000209:etiology*
chemical_list: D009294:Narcotics
keywords: Falls; hospital; injury; narcotics; patient safety