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Documentation of in-hospital falls on incident reports: Qualitative investigation of an imperfect process

DOI: 10.1186/1472-6963-8-254

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Abstract:

This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories.Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists.A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.Reporting of falls on hospital incident reports is an accepted standard for collating falls data in both clinical practice and research. [1-4] Concerns have previously been expressed regarding the ability of this system to accurately measure the "true" number of falls taking place on hospital wards.[3] In particular, discrepancies in the definition of a fall used in different facilities, time pressures on staff and the existence of a "blame" culture have been postulated to contribute to inconsistency in reporting and under-reporting respectively.[3,5,6]It is plausible that more f

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