The common denominator for hospital fall causation is the bed, and the common theme for intervention is the nurse. Most falls are not witnessed they are sometimes reported by patients, and sometimes reported by nurses or relatives, having heard the fall or found the patient on the floor. It should be noted that most of the research exploring patient falls from the bed lacks precision. We ask nurses to do hourly toileting rounds (when they are caring for six or eight patients) we ask nurses to assist the patient out of bed (and injuries to nurses’ backs are at epidemic levels). Moreover, the sound of the bed alarm may be muted by ambient noise in the unit, or the nurse may be occupied with other essential tasks, hence unable to immediately rescue the patient. The responsibility for fall intervention has been placed squarely on the shoulders of nurses: We ask nurses to observe, yet patients are in individual rooms and out of nurses’ direct line of sight we ask nurses to respond to bed alarms, yet the delay before alarm sounds (once the patient is off the bed deck) is a up to 9 seconds. Their beds are at a substantial distance from the bathroom, and the distance from the bed to the bathroom in some institutions was measured to be as much as 16 feet, and usually without a handhold or support. Unfortunately, those we ask are ill, confused, overestimate their abilities, are unable to stand and walk safely, and/or need to get to the bathroom urgently. Our professional response to this phenomenon is extraordinary: We continually ask the patient to use the call bell, to stay in bed until the nurse arrives, and not to get out of bed without assistance. Falls occur frequently when the patient is getting into bed, is reaching from the bed, rolls out of bed, is transferring from a wheelchair, or is getting into or climbing out of bed. Nevertheless, although fall rates vary considerably, it is apparent that the bed is a major factor in patient falls. However, how the fall was recorded alters our count of “falls from the bed.” If, for instance, the fall was recorded as “patient found on floor” and the activity was “going to the bathroom,” the fall may actually be a “getting-out-of-bed” fall, with the forward trajectory of the fall resulting in the patient found on the floor some distance from the bed. Analysis of type and number of falls in a community hospital recorded 51% of falls occurred getting into or out of bed 95% of these resulted in minor injury, and 4.95% resulted in major injury ( Tzeng, 2010). Other considerations are the patient’s condition, the quality of the nursing care (falls are now a nurse-sensitive measure Williams, 2004), and the nurse-to-patient ratio ( Dunton, Gajewski, Taunton, & Moore, 2004). This variation depends on the amount of time a patient occupies the bed (for instance, fall rates are lower if the patient is out of bed for a number of hours per day: They have less opportunity to fall from the bed). Estimates for the number of falls in hospital range from 20% from the bed ( Healey & Scobie, 2007) to approximately 60% to 70% “from bed or bedside chair” ( Oliver, 2002, p.
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