Who, what, when, where, how, and why are the important elements of any story and are the essential components of any narrative being reported to improve patient safety. 

Consider the following two examples of reports of patient falls: 

Narrative 1: “Patient found on floor.” 

Narrative 2: “Patient pushing off seat of folding chair in PT trying to get up, unassisted without supervision.  Left hand slipped; lost balance; slid onto floor.  Attendant otherwise occupied with finding information about patient’s room for transfer after session.”  

Which narrative conveys more useful information? Falls are among the most common problems reported by Pennsylvania acute health care facilities, and their causes are varied. Patients’ mental and physical status, protective devices, supervision, medications, and elimination needs are all potential contributors. The solutions are also varied, and one’s ability to help prevent falls depends on understanding the causes. It is also useful to know the consequences of falling for patients with different risk factors.

It is even more important to know the characteristics of the high-risk patient, the relationship between potential causes and the tendency to fall, and the effective recovery actions of caregivers that minimize patient harm. Reporting falls—particularly, reporting incidents that did not cause harm—can help identify these relationships, but only if the narratives contain relevant information.  Many facilities already have fall assessment and reduction programs.