According to the report Never Events for Hospital Care in Canada, three of the fifteen never events are associated with patient trauma during hospitalization:
Additionally, evidence from the Canadian Adverse Event Study, indicates that adverse events classified as 'Other', including burns and falls was the sixth leading cause of an adverse event in Canada (Baker, Norton, et al, 2004).
A fall is defined as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, the ground or other surface (e.g. mat). Injuries sustained by visitor slips, trips, and falls can result in significant harm and costs. Falls can be classified as:
Anticipatory (patients exhibit clinical signs that contribute to increased falls risk),
Unanticipated (physiological falls that cannot be predicted before first occurrence) and
Accidental (result of mishaps)
Anticipated falls can be prevented through screening for falls risk factors, communication and in-depth assessment and implementation of targeted prevention strategies (HIROC 2016).
A range of risk factors (>400) have been identified as influencing whether individuals are likely to fall. The BBSE MODEL of fall-related risk factors identifies biological (intrinsic), behavioural, social and economic and environmental (extrinsic) risk factors. The more risk factors an individual has, the greater the risk of falling (Safer Healthcare Now! 2013; RNAO 2017).
Falls may cause considerable physical harm, including fractures, soft tissue injuries, haematomas, lacerations and pressure sores due to subsequent immobility; as well as psychological distress such as fear of falling and humiliation and potentially resulting in chronic pain, loss of independence, reduced quality of life, and even death (Johal 2009; Public Health Agency of Canada 2014; Accreditation Canada, CIHI, CPSI 2014).
Studies in acute care settings show that fall rates range from 1.3 to 8.9 falls per 1,000 patient days, with higher rates in units that focus on geriatric care, neurology, and rehabilitation (Oliver 2010). Research shows that close to one-third of falls can be prevented (Ganz, et al. 2013/2018).
Burns to skin (or other organs) is a function of both temperature and duration. Even moderate heat applied for a long duration is capable of producing burns. There are three key conditions that predispose patients to burns including insensitivity to pain/temperature, unresponsiveness, or inability to communicate. In addition, impaired ability for the vasculature to help dissipate heat from the skin may predispose a patient to a burn (Patient Safety Solutions 2010).
Hospital emergency rooms and operating rooms contain the three primary elements needed to ignite a fire:
Fires that ignite in or around a patient during surgery are a real danger and are especially devastating if open oxygen sources are present during surgery of the head, face, neck, and upper chest (ECRI 2016).
A search of patient safety reporting/alert systems revealed that the potential causes of accidental burns include:
Asphyxia is severe hypoxia leading to hypoxemia and hypercapnia, loss of consciousness, and, if not corrected, death. There are many circumstances that can induce asphyxia; some of the more common causes are drowning, electrical shock, aspiration of vomitus, lodging of a foreign body in the respiratory tract, inhalation of toxic gas or smoke, and poisoning (Mosby's Medical Dictionary 2009). A search of patient safety reporting/alert systems revealed that the potential causes of iatrogenic asphyxia include:
To prevent in-hospital patient injury such as fractures, dislocations, burns, asphyxia etc. from occurring in patients.