Authors (including presenting author) :
Wong MK, Cheung MC, Yu ON, Ho WK, Chan WY, So TWP
Affiliation :
Occupational Therapy Department, North Lantau Hospital (NLTH)
Introduction :
Fall related incidents in ward is a well-known risk that warrant multi-level control measures due to possible of severe consequences. Owing to multifactorial nature in causation, Occupational Therapist plays an essential role in early detection of major risk contributors (e.g. declined mental function, ADL performance, etc.) and the timely offer of opinions to clinical team members in formulation of comprehensive fall prevention program, in both ward environment and upon patient’s discharge.
Objectives :
Occupational Therapists of NLTH contribute expert opinions to identify earlier multi-dimensional risk factors leading to patient fall and to offer timely intervention for promotion of safe transition from ward to home environment.
Methodology :
Patients admitted to EM Ward with Morse fall scale (MFS) >=45 were referred to OT for fall assessment and intervention. Abbreviated Mental Test (AMT), HK-MoCA 5 mins, Modified Barthel Index (MBI) and Fall Risk Assessment Tool (FRAT) were adopted as multi-dimensional assessments of fall risk. Patients identified with high fall risk will be notified to all team members for the formulation of fall prevention strategies including advices on level of support required in patient care, reality orientation, ADL training, care-giver education and home environment safety advices.
Result & Outcome :
A total of 194 patients were engaged in which 47 % were male and 53 % were female. Their mean age was 79. 75 patients had fall history in past six months (15.5% had 2 or more than 2 falls). 49% (N=95) had AMT score less than 8, indicating likelihood of cognitive impairment.
After Occupational Therapist’s intervention, patient’s mean MBI increased from 63.4 to 68.0. FRAT high fall risk status reduced from 61.3 %( N=119) to 39.7% % (N=77). The top two risk factors leading to fall were identified as mobility and transfer which also decreased by 10.8 % and 8.8 % respectively. Most importantly, 53% (N=103) patients continued living with carer in own home and 8 % ( N=17) could live alone upon discharge. Nil fall incident was reported during their hospital stay.
The multidimensional fall assessment conducted by Occupational Therapist, targeting the cognitive, ADL and environmental facets provides essential information for clinical team to mitigate risk of patient fall in both ward and home environment.
A service model that facilitate an early intervention upon hospital admission and the follow through of patient’s journey will help to prevent fall related injury as well as subsequent hospital admissions.
