Falls are the most common cause of accidental injury in the hospital and the most common reason that nurses need to file incident reports (Perell et al., 2001; Fonda, Cook, Sandler & Bailey, 2006). Thirty percent of falls result in patient injury. Four to six percent result in serious injuries, the most common being lacerations, fractures and head injuries. Two to three percent of falls may result in hip fracture (Corsinovi et al., 2009; Oliver, Healy & Haines, 2010; Hitcho et al., 2004). The incidence of falls varies depending upon the age of the patients and the type of problem for which they are admitted to the hospital (Cina-Tschumi, Schubert, Kressing, De Geest & Schwendimann, 2009). Rehabilitation units have high rates of falls. Lee and Stokic (2008) reported that 9.5% of 1472 consecutive admissions to an inpatient rehabilitation facility (IRF) fell during their hospitalization. Studies indicate that 20%–40% of patients admitted to an IRF after a stroke fall at least once during their stay on the unit (Teasell, McRae, Foley & Bhurdig, 2002; McLean, 2004; Dromerick & Reding, 1994; Nyberg & Gustafson, 1995; Saverino, Benevolo, Ottonello, Zsirai & Sessarego, 2006).
According to the American Geriatrics Society, British Geriatrics Society Panel on Falls Prevention (2011) and the Agency for Healthcare Policy and Research (2012), the process of preventing falls begins with an assessment of each patient's risk of falling. The Morse Fall Scale (MFS) is a widely used tool to assess the risk of fall. It was developed by comparing the records of 100 patients who fell and 100 patients who did not fall and was confirmed by a prospective study of 2689 admissions to acute medical, surgical, long-term geriatric, and rehabilitation units (Morse, 1986; Morse, Black, Oberle & Donahue, 1989). The scale has six variables: history of falls (25 points), poor safety awareness (15 points), presence of at least one comorbid condition(15 points), difficulty with transfers or gait (15 or 30 points), need for ambulatory aides (15 or 30 points), and presence of an intravenous line or heparin lock (20 points). The scale is scored from 0 to 120 with higher numbers representing an increased risk of fall. It is recommended as a screening tool by the National Center for Patient Safety (2004).
The Functional Independence Measure (FIM) was developed by a task force of the American Academy of Physical Medicine and Rehabilitation (Hamilton, Granger, Sherwin, Zielezny & Tashman, 1987). It documents the amount of help that a patient needs to perform 18 tasks. These are as follows: eating, grooming, bathing, dressing upper body, dressing lower body, toileting, continence of bowel and of bladder, transfers from bed or wheelchair, transfer to commode, transfer to tub or shower, ambulation or use of wheelchair, ability to climb stairs, comprehension of language, expressive speech, social interaction, problem solving, and memory (Linacare, Heinemann, Wright, Granger & Hamilton, 1994). Each item is scored from 1 to 7 with seven meaning that the person can perform the task without assistive device and without help and one meaning that the task needs to be performed by a helper without any assistance from the patient. The minimum score is 18 and the maximum score is 126. The FIM is a reliable and valid measure of patient function (Stineman et al., 1996; Cournan, 2011). Glenny and Stolee (2009) reviewed 40 papers that assessed the reliability and validity of the FIM. They found that the test has high inter-rater reliability and that it is a valid measure of patient function in that scores on the FIM correlate well with scores on other measures of patient function such as the Barthel Index and the Functional Autonomy Measurement System. It can be used to help predict length of stay, outcome, cost of care and caregiver burden (Stineman et al., 1996; Heinemann, Linacare, Wright, Hamilton & Granger, 1994; Stineman & Williams, 1990; Forrest, Schwam & Cohen, 2002). The Centers for Medicare and Medicaid Services (CMS) require an IRF to measure each patient's function at the time of admission and at the time of discharge from the unit (Centers for Medicare & Medicaid Services, 2001). There have been studies suggesting that admission score on the FIM is inversely correlated with the likelihood that patients will fall during their stay on the IRF (Saverino et al., 2006; Zdobysz, Boradia, Ennis & Miller, 2005;Aizen, Shugaev & Lenger, 2007; Suzuki et al., 2005; Petitpierre, Trombetti, Carroll, Michel & Herrman, 2010; Gilewski, Roberts, Hirata & Riggs, 2007; Forrest et al., 2012; Kwan, Kaplan, Hudson-Mckinney, Redmen-Bently & Rosario, 2012).