Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care: A Sociotechnical Probabilistic Risk Modeling Study.
Jaakko Varpula, Maritta Välimäki, Johanna Pulkkinen and 1 others
PMID 36476941WHAT IT FOUND
Falls during psychiatric seclusion had a modeled 1.8% risk, or 9 of every 500 patients.
Biggest contributors were getting out of bed, standing from sitting, schizophrenia, bipolar disorder, and medication side effects such as dizziness.
Key findings
01The model estimated an overall fall risk in seclusion of 1.8%, or 9 of every 500 patients.
02The highest individual contributions were getting out of bed and moving from a seated to a standing position; schizophrenia, bipolar disorder, and Alzheimer's were the top diagnoses.
03The model identified medication side effects such as dizziness, muscle weakness, and arrhythmia, along with narrow base of support, obesity, and gait abnormality, as high-probability reasons for falls.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
No patients were recruited, so risk factors and probabilities came from literature and nurse estimates rather than patient experience. Some probability estimates relied only on individual studies or professional discussion, and the model did not assess whether time in seclusion changes fall risk. The fall risk and risk factors were assigned prospectively, so the model has not been checked against actual falls in seclusion in retrospective studies. Some important risk factors were left underdeveloped, and elderly patients and medical history were removed after sensitivity analysis because their contribution was not specified. The literature used was mainly about falls in general psychiatric inpatient care, so it may underestimate risk for patients in seclusion, who have more severe behavioural disturbances. Incident reports underreport adverse events and often do not explain causes, which limits confidence in the probability estimates.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read the 1.8% modeled risk as proof that a fall prevention programme works. This study built a risk model from literature and nurse estimates, did not include patients, and did not test any intervention.