Causes of Post Stroke Falls Along the Care Continuum: Implications for Improving Patient Safety

In Western countries stroke is responsible for 10-12% of all deaths. In 2000, strokes cost $3.6 billion for the Canadian healthcare system and lost productivity due to premature death and long-term disability. Falls are a frequent occurrence at all stages of post-stroke recovery and can have significant negative impacts. While information about the incidence and risk factors of falling among stroke survivors is available, considerably less is known about the specific factors contributing to falls and the circumstances surrounding these adverse events. The purpose of this project was to identify similarities between systemic factors of falls in stroke survivors across the continuum of care. Sixty-eight stroke survivors were enrolled and monitored for falls for six months post-stroke. A total of 22 falls across the care continuum were investigated using the Systemic Falls Investigative Method (SFIM). Comprehensive data was collected through multiple interviews, document reviews, environmental scans, re-creation of events and was entered into the SFIM Database to produce falls reports. The guiding framework in data reduction and analysis was the Swiss Cheese Model of Accident Causation. Using within-case and across-case analyses, a total of 755 contributing factors were identified and grouped into patterns. Patterns were reported with prevalence rates of 100%, 80-99% and 60-79%. Patterns unique to a particular setting were also reported. When considering falls prevention programs in post-stroke rehabilitation and community re-integration, it is important to address not only stroke-specific health causes of falls (for example, poor balance, poor judgment), but also latent system-wide components (for example, inadequate supervision, insufficient community support) that affect stroke survivor’s safety