title: The characteristics of falls in an inpatient traumatic brain injury rehabilitation setting.
abstract: OBJECTIVE
  To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting.
  
  
  BACKGROUND
  Falls are the most frequently recorded patient safety incident in the inpatient context. However, higher rates of falls are reported in rehabilitation settings compared to acute care settings. In the rehabilitation setting, patients with a traumatic brain injury have been identified as at a high risk of falling. However to date, research into the nature of falls involving this patient population is limited.
  
  
  METHODS
  Five-year retrospective cohort study design.
  
  
  METHODS
  Falls data from an inpatient traumatic brain injury rehabilitation unit were retrieved from the NSW Ministry of Health Incident Information Management System and patient clinical notes; nursing shift data were retrieved from the local rostering system.
  
  
  RESULTS
  The fall rate was 5·18 per 1000 patient bed days. Over a 24-hour period falls (n = 103) occurred in a trimodal pattern. The median fall free period after admission was 14 days and 22% of traumatic brain injury patients had at least one fall. 53% of falls occurred in the patient's bedroom and 57% were attributed to loss of balance. At time of fall, 93% of fallers had impaired mobility and 85% required assistance for transfers.
  
  
  CONCLUSIONS
  Falls within inpatient traumatic brain injury rehabilitation are a significant and complex clinical issue. While many patients continued to be at risk of falling several months after admission, a repeat faller's first fall occurred earlier in their admission than a single faller's.
  
  
  CONCLUSIONS
  Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient's risk of falling is not static and in fact, may increase over time.
authors.affiliation: Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.|Brain Injury Unit, Royal Rehab, Sydney, NSW, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: McKechnie
authors.affiliation: Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.|Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia.
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Fisher
authors.affiliation: Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.|Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Pryor
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000451:nursing / Q000523:psychology / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009736:Nursing Process; D012189:Retrospective Studies
keywords: brain injury; falls; head injury; rehabilitation