Authors (including presenting author) :
CHUNG MF(1),CHAN MY(1),TAM TL(1),WONG FS(1),KWAN SCW(1),LEE MM(1),POON WYM(2),TSUI SKA(2)
Affiliation :
(1)Nursing Department, Hong Kong Buddhist Hospital,(2)Physiotherapy Department, Hong Kong Buddhist Hospital
Introduction :
Patient fall has been ranked the highest on the HKBH Risk Register since 2018 and risk mitigation is our top priority to ensure patient safety. In the first half of 2020, there was an increasing trend of patient fall rate. It increased from 0.38 in the first quarter to 0.47 in the second quarter of 2020. In benchmarking with the overall patient fall rate of 0.45 in all HA hospitals, there is room for improvement at HKBH. HKBH in-patients are mainly categorized into three specialties, Palliative Care, Medical Convalescence and Orthopedics. Orthopedic patients ranked the highest when comparing the fall rate with other specialties, they were regarded as our target patient group for fall prevention.
Objectives :
(1) to enhance staff communication and alertness on patent’s ambulatory status
Methodology :
By conducting a root cause analysis of fall incidents among Orthopedic patients in the first half of 2020, their ambulatory status at the time of fall was reviewed. It was revealed that 50% (3 out of 6) of them sustained a fall incident after being assessed to be able to walk with frame independently (except one refused exercise and became agitated when approached by physiotherapist), of which 66.7% (2 out of 3) fell within two days. This reflected that the patients might have over-estimated their ability and were not aware of fall risk, therefore did not ask for any assistance. In view of this, target approach on increasing patients’ awareness on fall risk and staff alertness on patient’s ambulatory status was adopted for this patient group. The Probationary Walking License has been launched since 7 September 2020 to Orthopedic patients who are able to walk with frame independently after physiotherapists’ assessment. The signage is designed to last for two days, with patient’s condition and ambulatory status to be reviewed in due course to determine any need of extending the ‘probationary period’. Moreover, nurses also stay vigilant and accompany the target patients for ambulation at night time.
Result & Outcome :
(1) No Orthopedic patients reported fall while on Probationary Walking License for 250 days (2) Fall rate dropped 35.85% from 1.06 to 0.68 at 250-day intervals (3) Positive feedback was received from staff on paying extra attention to target patients for safety concerns. The Probationary Walking License had been successfully implemented among Orthopedic patients. The result was promising as fall rate decreased appreciably. Ongoing monitoring of staff and patient compliance to ensure sustainability and the effectiveness to achieve patient safety outcomes in long run would be observed.
