Authors (including presenting author) :
CHAN YK (1), LI PY (1), LUI BKP (1), TSOI YK (1), YUEN WM (1), HO SKS (1), MAK PKF (1), KNG PLC (1)
Affiliation :
(1)Department of Medicine and Geriatrics, Ruttonjee and Tang Shin Kin Hospitals
Introduction :
Frail dependent elderly with multi-morbidity are common in medical wards. Patient fragility factors predispose to easy injuries like skin tears, bruising and fractures, which lead to adverse patient outcomes and complaints. Current manual handling guidelines focus on staff safety and targets generic patient. It does not address the special handling techniques to meet the growing needs of fragile elderly with severely osteoporosis and limb contractures who occupy our hospital beds.
Objectives :
This CQI aims to reduce hospital-acquired injury of fragile elderly (HAI-FE) during patient mobilization and handling.
Methodology :
HAI-FE was defined as fractures and skin injuries in frail elderly who depended on nursing assistance for dressing, bed mobility, transfers and nappy care. AIRS, RCA reports and case notes of patients with fragility related injuries in the past 2 years were retrieved to identify causal risk factors and potentially preventable factors by geriatric nurse managers with more than 5 year elderly care experience. Bundle of interventions were designed according to the identified risk factors and delivered to all 5 geriatric wards in hospital.
Result & Outcome :
A fishbone diagram classified 4 groups of risk factors: (a) intrinsic patient factors; (b) manoeuvre related factors; and (c) staff background (ward nurse versus non-ward based phlebotomists, porters etc) training and (d) family education and communication. Interventions consisted of (1) Identify & Alert Cards - admission assessment for risks eg osteoporosis, stroke and alert to ward, non-ward staff and relatives (2) Multidisciplinary Expertise ( with allied health) to devise and train safe handling techniques for bedside care of fragile patient e.g napkin changing, garment changing (3) Training and Communication with all staff handling patient. Multiple hands-on bedside training sessions attended by more than 80% of nursing and supporting staff. (4) Empower Family by nurses teaching with educational toolkit. Outcomes since implementing bundle of interventions are staff ( ward/nonward) and family awareness and empowerment have positive satisfaction. HAI-FE has multifactorial aetiologies for a complex patient group which are not addressed in current guidelines. Instead, we have described an effective bundle of interventions via a team approach and strong family engagement as the key enablers for safe quality elder-friendly care and preventing HAI.
