Authors (including presenting author) :
Wong CS (1), Chui WS (1),Lee SC (1),Kung CC (1), Ma MS(1), Ng HK(1), Lau CH(1), Mak CY(1), Shek KY(1), Chan KH(1), Cheng YT (1)
Affiliation :
(1)Department of Medicine and Geriatrics,Shatin Hospital
Introduction :
The fall rate of SH PC was 0.6/1,000 bed days which is higher than the mean of fall rate in group 2 hospital. In 2018, there were 12 fall cases in SH PC ward and the contributing factors were analysed in terms of patient factors, staff factors and other factors which might leading to patient fall.
As a result, the relevant actions were complemented in 2019.
Objectives :
1.To enhance staffs and patient's awareness on fall prevention measures
2.To minimize fall rate and related injuries as a ultimate outcome
Methodology :
Patient factors
For patient factors, data in 2018 showed that 58% of fall cases with Abbreviated Mental Test (AMT) score was 10/10 and 17% of fall cases involving carer at the time of fall, patient education was beneficial to the sound minded patients. Capone et al., (2012) also suggested that increase knowledge of oncology patients can prevent falls.
Three specific interventions were implanted. Firstly, specific fall scenario cue card was designed for patient education conducted by primary nurse. The cue card scenario was developed based on previous fall data.
Secondly, daily broadcast of fall education video was displayed on ward TV during visiting hours to enhance both patients and carers’s awareness. Thirdly, nursing staff was promoted to use the standardized fall precaution leaflet and highlighted individualized risk factors for fall to patients & relatives.
Staff factors
Staff played a vital role in fall prevention. Miake-Lye, Hempel, Ganz & Shekelle (2013) suggested that staff education, training and changes in attitudes could promote fall prevention
Three interventions were implemented during the program.
Firstly, previous fall data analysis was shared to front line nurses to enhance their knowledge and awareness. At the same time, supporting staff education on fall prevention was done. The content included sharing of previous fall scenario and highlighted the characteristics of fall cases.
Finally, safety ward round was promoted to enhance the patrol system in clinical setting. Supporting staffs needed to check the alarm system were well function and ensured patient wore hip protector with proper position and ensured other environmental factors was safe.
Other factors
As in 2018 data, 17% of patient fall during night time napkin round. Night shift routine was modified to improve the patrol system at ward.
Result & Outcome :
After program implemented from June 2019, total 4 fall cases in PC ward and all cases severity index were below 4. The fall rate of SH PC from June to Nov 2019 was 0.43 which was lower than the mean in 2018 0.64.
At the same time, staff evaluations (n=22) were also collected through online evaluation form.
For checking understand of the fall scenario cue card, 64% of staff agreed and 36% of staff strongly agreed that patient can understand the fall scenario indicated in the cue card.
Secondly, 77% of staff agreed and 23% of staff strongly agreed that staff also agreed that fall prevention video can enhance patients’ fall prevention awareness.
Furthermore, 73% of staff agreed and 37% of staff strongly agreed that safety ward round can enhance the checking of environmental factors leading to fall.
For modification of night shift routine, 64% of staff agreed and 36% of staff strongly agreed that modify of night shift routine can improve the patrol system at ward.
Finally, 64% of staff agreed and 36% of staff strongly agreed that the fall CQI can prevent patient fall. Staff became recognizing its benefit as part of fall prevention program to prevent fall. Positive feedback was received from frontline staff.
Falls in palliative setting are associated with different risk factors and nurses play an important role of fall prevention. By the education among patients, relatives and staffs, the risk of fall can be minimized.
