Falls on an inpatient rehabilitation unit: risk assessment and prevention

To determine the relationship between admission diagnosis and admission score on Functional Independence Measure (FIM) to the likelihood that a patient will fall. To measure the effectiveness of a multifactorial program to reduce falls.

The Quality Improvement Team put in place a multifactorial program to reduce the incidence of falls on an inpatient rehabilitation unit. The authors reviewed the records of all patients admitted to the rehabilitation unit between January 2006 and December 2009 to determine if the program resulted in a reduced rate of falls. The authors also reviewed the data to evaluate if admission score on the FIM and the diagnosis or impairment group of the patient are related to the risk of fall.

FIM score is inversely related to the rate of falls. Patients with admission diagnosis of stroke, brain injury, amputation, neurologic disorders (Parkinson's disease, multiple sclerosis, Guillain-Barre, myopathy, peripheral neuropathy), and spinal cord injury are at higher risk for fall than patients whose admission diagnosis related to orthopedic, cardiac, pulmonary disorders, prolonged stay on medical or surgical units, or trauma without spinal cord injury or head injury. There was a significant reduction in the rate of falls from 14.9% to 7.3% of patients admitted to the IRF.

Patients with low FIM scores, disorders of the central and peripheral nervous system, and amputations are at high risk of fall. Compliance with recommended guidelines can reduce the rate of fall and improve patient safety.

The rate of falls on an IRF will be determined in part by the case mix and functional levels of the patients on the unit. Strict adherence to appropriate nursing protocols can reduce the rate of falls.