Authors (including presenting author) :
Lee TK(1), Tse CY(1), Lee ASC(1), Kwok CY(1), Wong CY(1), Wong PPY(1)
Affiliation :
(1)Department of Psychiatry, Tai Po Hospital
Introduction :
Prevalence of fall is higher in psychiatric inpatient settings than general settings due to reasons including psychotropic medications’ side-effects and impaired cognitive function. Fall could cause adverse psychological impacts and serious injuries to patients including fractures. As estimated by a local paper, care of hip fractures cost HK $511 million for Hospital Authority in 2020. In Department of Psychiatry at Tai Po Hospital, there was an urgent need to reduce high number of fall incidents (32 in 2019; 37 in 2020). Based on 4M1E principle (Man, Mechanism, Material, Method, Environment), a series of systemic fall prevention (FP) enhancement actions were started in 2020.
Objectives :
Minimize 1) fall incidents; 2) fall-related fractures.
Methodology :
Man: Organized two identical 2-day training workshops with multi-disciplinary involvement to nurses in April and May 2021 to enhance FP evidence-based knowledge (e.g., fall risk assessment skills and psychiatric patients’ specific risk factors of fall); revised FP training content for nursing graduates. Mechanism: Regularized fall incidents and FP measures reporting in weekly nursing managers’ meeting; designated fall representatives for each ward to support FP measures and skills enhancement; enriched mechanism for post-fall environmental visit and fall incidents review. Material: Promoted utilization of FP and injury prevention equipment (e.g., wireless fall alarm mats, protective helmets); refined fall alert signage which included number of assistant(s) recommended for mobilization. Method: Enhanced assisted walking and controlled landing techniques via hands-on training sessions conducted to wards, which were completed in September 2021. Environment: Implemented environmental scan per shift by supporting staff (supervised by nurse-in-charge) to ensure FP measures are in order; refined bed assignment strategies and incorporated Modified functional ambulatory category (MFAC) findings. Evaluation: One-year period pre- and post- comparison (October 2020 – September 2021 vs October 2021 – September 2022) regarding number of fall incidents, fall incident rate and fall-related fracture cases.
Result & Outcome :
The number of fall incidents successfully dropped 22% from 27 to 21 and fall incident rate was reduced from 0.24 to 0.21. Further, fall-related fracture cases were reduced from 6 to 0. Falls are multifactorial accidents and therefore systemic improvement actions are needed to address multiple modifiable risk factors. All of aforementioned 4M1E management strategies are important, but to achieve positive and sustainable FP outcomes, the most crucial fuel would be collective cultural change among healthcare staff.
