title: Falls in critical care: a local review to identify incidence and risk.
abstract: BACKGROUND
  Patient falls are the most common adverse event in hospitals, resulting in devastating physical, psychological and financial consequences. Therefore the emphasis on falls assessment and prevention is a key priority. Within hospitals those reported at greatest risk of falls are older patients with little known about the factors within critical care. At a local level, a practice development project was identified to review risk factors contributing to falls in critical care.
  
  
  OBJECTIVE
  To identify the incidence of falls within adult critical care and the risk factors most likely to contribute to a fall.
  
  
  METHODS
  Reported falls incidents were reviewed retrospectively using a local incident reporting system, over a 2-year period from four critical care units.
  
  
  RESULTS
  Forty-two incidents were reviewed indicating a low rate of injury and low rate of occurrence (0·99 falls/1000 bed days). The median age of fallers was 58 years and the most common risk factor for falls was confusion or agitation, followed by patients attempting to mobilize against advice.
  
  
  CONCLUSIONS
  Critically ill patients were less likely to fall and were more likely to be younger than patients falling on an acute care ward. Neuroscience/trauma critically ill patients were more likely to fall than general critically ill patients; this was expected to be because of the increased presence of confusion or agitation in this group. The local system used to report falls produced difficulties in identifying risk factors in a consistent way. Although limitations exist, this review has enabled the development of more suitable local critical care falls risk factor assessment and interventions to minimize the risk of falling.
  
  
  CONCLUSIONS
  Fall rates, related injuries and circumstances of falls vary considerably among acute care and critical care specialities. Future work should concentrate on better falls reporting systems and further research should include validating risk factors for critical care falls.
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Richardson
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Carter
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology*
keywords: Critical care; Falls assessment; Falls risk factors; Quality improvement