Patients with stroke are at high risk of falls during inpatient rehabilitation admission. Communication disability is common following stroke; however, this population is often excluded from falls research. This study aimed to examine the falls of patients with communication disability following stroke, including the circumstances, contributing factors, and outcomes of the fall. This medical record review used the Generic Reference Model of patient safety as the analytical lens and data were analyzed descriptively. The study included 109 patients who experienced 308 falls. The most common type of fall was an “unwitnessed roll from bed.” Patient factors contributed to half of all falls, injuries occurred in 15% of falls, and impacts to the hospital system included additional costs and staffing. Understanding the reasons why patients are attempting to get out of bed may identify ways to reduce the risk and incidence of falls in this population.
AiharaS.KitamuraS.DoganM.SakataS.KondoK.OtakaY. (2021). Patients’ thoughts on their falls in a rehabilitation hospital: A qualitative study of patients with stroke. BMC Geriatrics, 21(1), 713. https://doi.org/10.1186/s12877-021-02649-1
2.
BalandinS.HemsleyB.SigafoosJ.GreenV.ForbesR.TaylorC.ParmenterT. (2001). Communicating with nurses: The experiences of 10 individuals with an acquired severe communication impairment. Brain Impairment, 2(2), 109–118.
3.
BartlettG.BlaisR.TamblynR.ClermontR. J.MacGibbonB. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings.Canadian Medical Association Journal, 178(12), 1555–1562. https://doi.org/10.1503/cmaj.070690
4.
BatchelorF.HillK.MacKintoshS.SaidC. (2010). What works in falls prevention after stroke? A systematic review and meta-analysis. Stroke, 41(8), 1715–1722. https://doi.org/10.1161/STROKEAHA.109.570390
BlaisR.BrunoD.BartlettG.TamblynR. (2008). Can we use incident reports to detect hospital adverse events?Journal of Patient Safety, 4(1), 9–12.
7.
BugdayciD.PakerN.DereD.OzdemirE.InceN. (2011). Frequency, features, and factors for falls in a group of subacute stroke patients hospitalized for rehabilitation in Istanbul. Archives of Gerontology and Geriatrics, 52(3), e215–e219. https://doi.org/http://dx.doi.org/10.1016/j.archger.2010.11.014
8.
CampbellG. B.MatthewsJ. T. (2010). An integrative review of factors associated with falls during post-stroke rehabilitation. Journal of Nursing Scholarship, 42(4), 395–404. https://doi.org/10.1111/j.1547-5069.2010.01369.x
9.
ChaiwanichsiriD.JiamworakulA.KitisomprayoonkulW. (2006). Falls among stroke patients in Thai Red Cross Rehabilitation Centre. Journal of the Medical Association of Thailand, 89(Suppl 3), S47–S52.
10.
ConstantinouE.SpencerJ. A. (2020). Analysis of inpatient hospital falls with serious injury. Clinical Nursing Research, 30(4), 482–493. https://doi.org/10.1177/1054773820973406
11.
CzernuszenkoA. (2007). Risk factors for falls in post-stroke patients treated in a neurorehabilitation ward. Neurologia i Neurochirurgia Polska, 41(1), 28–35.
12.
CzernuszenkoA.CzlonkowskaA. (2009). Risk factors for falls in stroke patients during inpatient rehabilitation. Clinical Rehabilitation, 23(2), 176–188. https://doi.org/http://dx.doi.org/10.1177/0269215508098894
13.
DenissenS.StaringW.KunkelD.PickeringR. M.LennonS.GeurtsA. C.VerheydenG. S. (2019). Interventions for preventing falls in people after stroke. Cochrane Database of Systematic Reviews, 10(10), CD008728. https://doi.org/10.1002/14651858.cd008728.pub3
14.
HainesT. P.CornwellP.FlemingJ.VargheseP.GrayL. (2008). Documentation of in-hospital falls on incident reports: Qualitative investigation of an imperfect process. BMC Health Services Research, 8, 254. https://doi.org/10.1186/1472-6963-8-254
15.
HainesT. P.MasseyB.VargheseP.FlemingJ.GrayL. (2009). Inconsistency in classification and reporting of in-hospital falls. Journal of the American Geriatrics Society, 57(3), 517–523. https://doi.org/10.1111/j.1532-5415.2008.02142.x
16.
HemsleyB.SteelJ.WorrallL.HillS.BryantL.JohnstonL.GeorgiouA.BalandinS. (2019). A systematic review of falls in hospital for patients with communication disability: Highlighting an invisible population. Journal of Safety Research, 68, 89–105. https://doi.org/10.1016/j.jsr.2018.11.004
17.
HemsleyB.WerninckM.WorrallL. (2013). “That really shouldn’t have happened”: People with aphasia and their spouses narrate adverse events in hospital. Aphasiology, 27(6), 706–722. https://doi.org/10.1080/02687038.2012.748181
18.
HillA.-M.McPhailS. M.WaldronN.Etherton-BeerC.IngramK.FlickerL.BulsaraM.HainesT. P. (2015). Reducing falls in rehabilitation hospital units using individualised patient and staff education: A pragmatic stepped-wedge cluster randomised controlled trial. The Lancet, 385(9987), 2592–2599.
19.
HillK. D.VuM.WalshW. (2007). Falls in the acute hospital setting – impact on resource utilisation. Australian Health Review, 31(3), 471–477.
20.
MillmanE. A.PronovostP. J.MakaryM. A.WuA. W. (2011). Patient-assisted incident reporting: Including the patient in patient safety. Journal of Patient Safety, 7(2), 106–108.
21.
MionL.GregorS.BuettnerM.ChwirchakD.LeeO.ParasW. (1989). Falls in the rehabilitation setting: Incidence and characteristics. Rehabilitation Nursing, 14(1), 17–22. https://doi.org/10.1002/j.2048-7940.1989.tb00667.x
22.
MitchellC.GittinsM.TysonS.VailA.ConroyP.PaleyL.BowenA. (2020). Prevalence of aphasia and dysarthria among inpatient stroke survivors: Describing the population, therapy provision and outcomes on discharge. Aphasiology, 35(7), 950–960. https://doi.org/10.1080/02687038.2020.1759772
23.
MorelloR. T.BarkerA. L.WattsJ. J.HainesT.ZavarsekS. S.HillK. D.BrandC.SherringtonC.WolfeR.BohenskyM. A.StoelwinderJ. U. (2015). The extra resource burden of in-hospital falls: A cost of falls study. Medical Journal of Australia, 203(9), 367.e1–367.e8. https://doi.org/10.5694/mja15.00296
RafterN.HickeyA.CondellS.ConroyR.O’connorP.VaughanD.WilliamsD. (2015). Adverse events in healthcare: Learning from mistakes. QJM, 108(4), 273–277. https://doi.org/10.1093/qjmed/hcu145
26.
RuncimanW. B.WilliamsonJ. A. H.DeakinA.BenvenisteK. A.BannonK.HibbertP. D. (2006). An integrated framework for safety, quality and risk management: An information and incident management system based on a universal patient safety classification. Quality and Safety in Health Care, 15(Suppl. 1), i82–i90. https://doi.org/10.1136/qshc.2005.017467
27.
ShojaniaK. G.van de MheenP. J. M. (2020). Identifying adverse events: Reflections on an imperfect gold standard after 20 years of patient safety research. BMJ Quality and Safety, 29(4), 265–270. https://doi.org/10.1136/bmjqs-2019-009731
28.
Simmons-MackieN.KaganA. (2007). Application of the ICF in Aphasia. Seminars in Speech and Language, 28(4), 244–253. https://doi.org/10.1055/s-2007-986521
29.
SullivanR.HardingK. (2019). Do patients with severe poststroke communication difficulties have a higher incidence of falls during inpatient rehabilitation? A retrospective cohort study. Topics in Stroke Rehabilitation, 26(4), 288–293. https://doi.org/10.1080/10749357.2019.1591689
30.
SullivanR.HardingK.SkinnerI.HemsleyB. (2020). Falls in hospital patients with acquired communication disability secondary to stroke: A systematic review and meta-analysis. International Journal of Language & Communication Disorders, 55(6), 837–851.
31.
SullivanR.HardingK.SkinnerI.HemsleyB. (2021). Circumstances and outcomes of falls in hospital for adults with communication disability secondary to stroke: A qualitative synthesis. Advances in Communication and Swallowing, 24(2), 99–110. https://doi.org/10.3233/ACS-210028
32.
SullivanR.SkinnerI.HardingK.HemsleyB. (2022). Hospital policies on falls in relation to patients with communication disability: A scoping review and content analysis. Manuscript submitted for publication.
33.
SuzukiT.SonodaS.MisawaK.SaitohE.ShimizuY.KotakeT. (2005). Incidence and consequence of falls in inpatient rehabilitation of stroke patients. Experimental Aging Research, 31(4), 457–469. https://doi.org/10.1080/03610730500206881
34.
SzeK. H.WongE.LeungH. Y.WooJ. (2001). Falls among Chinese stroke patients during rehabilitation. Archives of Physical Medicine & Rehabilitation, 82(9), 1219–1225.
35.
UllahS.Al-AtwiM. K.QureshiA. Z.TantawyS. S.IlyasA.WunderlichC. A. (2019). Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia. Neurosciences, 24(2), 130–136. https://doi.org/10.17712/nsj.2019.2.20180032
36.
VassarM.MatthewH. (2013). The retrospective chart review: Important methodological considerations. Journal of Educational Evaluation for Health Professions, 10, 12. https://doi.org/10.3352/jeehp.2013.10.12
37.
WalshM. E.HorganN. F.WalshC. D.GalvinR. (2016). Systematic review of risk prediction models for falls after stroke. Journal of Epidemiology & Community Health, 70(5), 513–519. https://doi.org/https://dx.doi.org/10.1136/jech-2015-206475
38.
WatsonB.SalmoniA.ZecevicA. (2019). Case analysis of factors contributing to patient falls. Clinical Nursing Research, 28(8), 911–930. http://doi.org/10.1177/1054773818754450
39.
WongJ. S.BrooksD.MansfieldA. (2016). Do falls experienced during inpatient stroke rehabilitation affect length of stay, functional status, and discharge destination?Archives of Physical Medicine and Rehabilitation, 97(4), 561–566. https://doi.org/10.1016/j.apmr.2015.12.005
ZdobyszJ. A.BoradiaP.EnnisJ.MillerJ. (2005). The relationship between functional independence scores on admission and patient falls after stroke. Topics in Stroke Rehabilitation, 12(2), 65–71. https://doi.org/10.1310/G89Q-80VR-P5P7-9PTH
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