In mid-2010, a Pennsylvania healthcare worker asked a Pennsylvania Patient Safety Authority Patient Safety Liaison which medications were related to falls in facilities licensed exclusively as behavioral health hospitals. The Authority believes that all facilities can learn from the results of a look at the Authority’s database.
The Authority looked specifically at falls reported from behavioral health hospitals. Reports from nonbehavioral health hospitals were used for comparisons. In 2009 (the last full calendar year of event reports preceding the request), falls reported by behavioral health hospitals constituted 0.9% of the overall number of falls reported to the Authority. Reports of falls in behavioral health hospitals were more likely to involve patient harm; 9.6% of behavioral health falls were Serious Events, compared to 3.7% of those submitted by other hospitals (p < 0.001 by chi-square). (See Table 1.) In 2009, falls accounted for 21.7% of submitted reports in behavioral health hospitals compared to 15.4% in nonbehavioral hospitals.
|HOSPITAL ||INCIDENT ||SERIOUS EVENT ||TOTAL|
|Behavioral health hospitals||283||90.4%||30||9.6%||313|
|Nonbehavioral health hospitals||33,349 ||96.3%||1,292 ||3.7%||34,641|
|% behavioral health hospitals / total||0.8%||—||2.2%||—||0.9%|
The leading associated medications at behavioral health hospitals differ from other hospitals. Table 2 lists the medication types mentioned in reports, sorted by hospital type. Antipsychotics and benzodiazepine were predominant among behavioral health hospitals and were less common in other hospitals, reflecting the differences in conditions being treated. Behavioral health hospitals reported a greater percentage of medications related to falls than other hospitals (70.3% versus 57.6%, p < 0.001 by chi-square).
|MEDICATION TYPE |
FALLS EVENTS AT BEHAVIORAL HEALTH HOSPITALS (N = 313)
FALLS EVENTS AT NON-BEHAVIORAL HEALTH HOSPITALS (N = 4,641)
|Number ||Percentage*||Number ||Percentage*|
|* Percentages calculated on number of falls in each medication category, not accounting for the lack of medications involved nor multiple medications. Additionally, not all submissions noted medications. |
The age of patients falling at behavioral health hospitals is noticeably younger than those falling at nonbehavioral health hospitals. The average age of the falling patient at behavioral health hospitals is 45 years whereas the average age at nonbehavioral hospitals is just over 65 years. The Figure presents the percentage breakdown by age cohort of behavioral health and nonbehavioral health hospitals.Figure. Percentages by Patient Age Cohort of Falls Reported in 2009, by Hospital Type
Roughly 70% of falls reports from behavioral health hospitals and 58% from nonbehavioral health hospitals indicate medications were possibly involved in the fall. This shows that facilities should consider the medications that are being administered and how they may increase their patients’ risk of falls.
- Falls from behavioral health hospitals were more likely to be reported as harming the patient, according to the Authority data.
- A higher proportion of falls reported from behavioral health hospitals are medication-related than at nonbehavioral health hospitals.
- Patients in fall reports from behavioral health facilities are noticeably younger than in those from nonbehavioral health hospitals.