Authors (including presenting author) :
KWOK SY (1), CHOI HK (1), CHUNG KK (1), TING CT (1), SO PS (1), LAM PY (1), LI CM (1), CHUNG SHC (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Kwong Wah Hospital
Introduction :
Falls are a common and often devastating problem among older people, causing a tremendous amount of injuries, morbidity and mortality, which in turn, burdening the medical system by increasing the length of stay and the cost of treatment1, 2. Therefore, besides handling patient’s medical problem during hospitalization, prevention of fall for them is another important mission for the healthcare professionals1, 3. By introducing the fall prevention bundle, the fall rate can be reduced2.
Objectives :
Pilot program in employing the fall prevention bundle was started in E10 in the Department of Medicine & Geriatrics in Kwong Wah Hospital since Jan 1 2021 to provide a comprehensive approach for healthcare professionals to minimize the fall risk and thus, to enhance clinical safety. At the same time, this pilot program also served as another function to investigate the common reason, time, venue of fall incidents and to identify the common high fall risk patient group among the department, so that a more strategic plan on fall prevention intervention can be implemented in future.
Methodology :
This pilot program included the following elements, ward environment orientation, especially introducing the use of call bell, was reinforced to all new admission and newly transfer in cases. Extra session of early morning bedpan round was provided to patients daily. The routine of writing the Morse Fall Scale (MFS) score at a designated location in Nursing Kardex was standardized among the department to facilitate nurses to alert other healthcare professionals on patient’s fall risk. The use of Bed Exit Alarm System was lunched since Feb 23 2021. The weekly monitoring of MFS scoring skill was started by the Fall Prevention Workgroup members in E10 to identify the common scoring problem encountered by other nurses. Feedback for improvement and re-assessment would be given in case of any incompetency observed. Each fall incident encountered within this period was analyzed by the Fall Prevention Workgroup members in E10. The cause of each fall incident in E10 was shared and promulgated to the frontline nurses timely. Reinforcement of the nursing standard was also provided.
Result & Outcome :
During the period between Jan 1 2021 and Sep 30 2022, the fall rate in E10 greatly dropped from 3.05 to 0.00. The fall rate remained below 1.00 for most of the months over this period. 18 versus 8 fall incidents were identified in 2021 and 2022 respectively. After analyzing these 26 incidents in total, it is found that in patient’s perspective, male, aged between 81-90, pre-morbid: ambulatory with aid, able to get out of bed and with urge of urination had a higher risk to lead to fall incidence. Besides, the time of fall incident commonly happened during dinner times (18:00-20:00) or between handover time (14:30-15:30 and 22:30-23:30). The most common fall location is bedside. The most common reason of fall is losing balance or encountering lower limbs weakness during urination. In addition to the factor from patients and the environment, the incompetency of MFS scoring skill among nurses may also have a risk to contribute to the underscoring of the high fall risk cases, which in turn decreased the alertness of the front-line staff and hinders their decision to initiate a bed exit alarm system (BEAS) at a suitable occasion. Finally, this may lead to the increased risk of avoidable fall incidence. Besides, incompetency of frontline staffs on operating the BEAS during the fall prevention bundle pilot program was also observed. Some staffs set up invalid BEAS and this make the alarm muted when patients left their beds. The above results were shared among the front-line nurses with the reinforcement of the nursing standard. The respective preventive measures were also shared.
With the use of the fall prevention bundle, the fall rate in E10 was greatly reduced. In future, it is hoped to enlarge the scale of the fall prevention bundle by promoting on the use of BEAS through “train the trainer” workshop.
