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Is There an Association of Inpatient Falls and Hyponatremia? FREE TO VIEW

Fariborz Rezai, MD; Samson Assefa, MD; Olga Takshyna, BS; Lindsey Boss, BSN; Ruchika Sethi, BSN; Evangeline Kupyak, CCRN; Julie Egan, BSN; Edilrhia Eusebio, BSN; Elizabeth Singler, BSN; Gesmene Ulysse, BSN; Jaclyn Lawlor, BSN
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Saint Barnabas Medical Center, Livingston, NJ

Chest. 2013;144(4_MeetingAbstracts):574A. doi:10.1378/chest.1702741
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SESSION TITLE: Patient Safety Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Inpatient falls can not only be life threatening but also very costly to patients and institutions, and can lead to increased morbidity and mortality. Reduction in falls should be a priority for hospital quality and patient safety. In the literature , advanced age, treatment-related factors and change in mental status were among the risk factors for falls in an inpatient setting. It is described in the literature that patients with hyponatremia are at increased fall risk possibly from marked gait and attention impairments.

METHODS: We performed a retrospective review of medical records to examine the association of falls with hyponatremia in the hospital setting. The records of all patients admitted to Saint Barnabas Medical Center between January 2009 and May 2012 were reviewed using a computer assisted search. Inclusion criteria were patients 18 years or older who had a documented fall during hospitalization, hospital stay greater than one day, and at least one serum sodium level measured at admission and one within 24 hours before or after the fall. A total of 969 patients were identified using the inclusion criteria noted. We then compared admission serum sodium levels with levels at the time of the fall.

RESULTS: Nine hundred and sixty-nine patients between the ages of 19 to 101 years had falls during the study period. Of these, 495 (51%) were males and 475 (49%) females and the mean age was 66 years. Fifty six percent (543) of the patients were on medications that affect the nervous system, 41% (401) were on vasodilators, 24% (233 ) were on diuretics, and 82% (795) were on more than four medications. Twelve percent (113) had a history of stroke. The average sodium level was 137 mmol/L (normal 135-145) at admission and was no different around the time of fall. Only 20% (190) of patients had hyponatremia (sodium <135 mmol/L) during the fall which was similar to the number of patients with hyponatremia on admission 19% ( 182).

CONCLUSIONS: Our study suggests that there is no significant increase in the incidence of hyponatremia among hospitalized adult patients at the time of in-hospital falls. Hyponatremia might not be a predictor of falls in the hospital setting as it has been described in an outpatient setting. The results should be confirmed by larger multicenter studies.

CLINICAL IMPLICATIONS: If we demonstrated a relationship between inpatient falls and hyponatremia; then treatment of hyponatremia may prevent falls and improve patient safety, outcomes and lowering healthcare costs.

DISCLOSURE: The following authors have nothing to disclose: Fariborz Rezai, Samson Assefa, Olga Takshyna, Lindsey Boss, Ruchika Sethi, Evangeline Kupyak, Julie Egan, Edilrhia Eusebio, Elizabeth Singler, Gesmene Ulysse, Jaclyn Lawlor

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