Authors (including presenting author) :
MAK YM (1&2), HO YL(2), YEUNG W(1), CHAN LW(2), TSUNG WC(1), NG WC(2), MAK KS(1)
Affiliation :
(1) Infirmary Unit, Cheshire Home, Shatin, (2) Disable Unit, Cheshire Home, Shatin
Introduction :
Fall that occur in hospitalized patients are a widespread, serious threat to patient safety; and, falls in later life are highly prevalent and associated with an increased risk of mortality and morbidity. It is a common challenge among healthcare institutions to reduce falls. In Cheshire home, Shatin, Fall is the first priority of Risk Registry; and we believe that it is important to raise the awareness of staff in prevention of fall and post fall management. Also create a safety environment for patients.
Objectives :
To Enhance of fall prevention measures to patient. To prevent fall incident and minimize fall related injuries of patients throughout their hospitalization. To individualized fall prevention education to patients. To Improve post-fall management.
Methodology :
A series of measure have been implemented in 2019. Firstly, on top of the general measures like fall risk assessment with Morse Scale, and intervention plan in electronic patient care plan (ePCP); every patient received a specific-supplementary fall prevention care plan, which is unique, and tailor-made to the patient type in Cheshire Home Shatin. This fall risk assessment and intervention would be conducted on admission day and weekly.
Secondly, a “Bigger” High Risk signage would be posted up at the end of bed if a patient is classified as high fall risk. A designated Patient Care Assistant would be assigned to focus on the safety of the high fall risk case. Besides, an individualized “One-to-One” fall prevention education would be provided to patient and relatives if high risk is classified. Focal point of prevention would be emphasized during the education.
On the other hand, we strengthen the monitoring by enhancing the patrol system. Supporting staff performed patrol ward round in each shift duty to check if there was any patient at fall risk, check the environmental tidiness, use of call bell, use of fall alarm device and ensure safety alarm should be well-connected, and, give advice to patient to us reachable call bell whenever necessary.
Furthermore, relocation of patient who showed to have deteriorating in physical condition; Companion arrangement during the outing of patient; using hip protector for stick walker; reposition of buckle on the safety belt to the back of wheelchair. All these were the individual measure made.
And at last, we have also provided re-education to the carer on the skills of walking assistance. The workflow on fall prevention with post fall management were emphasized to staff as well.
Result & Outcome :
Result & outcome: From June 2019 to December 2019, data was analyzed. There were 5 fall incidents occurred in 1Q & 2Q 2019. Encouragingly, the number of fall incident occurred in ward area in 3Q & 4Q 2019 was minimized to Zero. The 2 cases of fall were happened during home leave of resident. Moreover, the compliance rate on the patrol ward round showed 100% and it should make environmental adaptations and provide personal devices to reduce risk of fall. Staff evaluation survey showing that more than 90% nursing staff agreed that the new measures, the supplementary fall prevention care plan and the bigger high risk signage at bed end, are more effective to identify and communicate the fall risk cases and increase the alertness. Individualized fall prevention education to patients and relatives should be better understanding on prevent of falls and injury. It was observed that fall incident occurred when patient was having out-door activity. Our way forward will be strengthening in this aspect. Conclusions: The positive result in fall prevention showed that fall prevention is benefited in comprehensive approach. Strategy not only focus on a single aspect, but also be individualized and in all domains.
