Authors (including presenting author) :
Kwok CY(1),Wong CY(1),Suen KY(1),Lau YS(1),Tsoi TM(1)
Affiliation :
(1) Department of Psychiatry, Tai Po Hospital
Introduction :
Patient fall is a safety concern in hospital that resulting in functional disability with longer hospitalization. Despite different fall preventive measures implemented but there is no specific intervention related to safe practice of patient toileting (Baker, 2016).Toilet-related activities continued to contribute high fall incident and injury with odds ratio 2.2 for fracture (Bower, et al, 2019). 88% toilet-related falls happened at night are related to patients mobilized without the recommended level of assistance (John, et al, 2019 & Collazo, et al, 2019). In our department, there was 54.1% fall incident related to patients with age ≥ 65 in 2020 in which most of them involved toilet-related activities. A proactive toilet training programme including escorting patients to toilet by trained staff with purposeful toilet schedule was conducted in psychogeriatric wards for toilet-related fall reduction.
Objectives :
1.To establish toilet schedule for patients to meet their elimination need 2.To preserve patient’s dignity during toileting 3.To promote safe toileting at night for fall risk patients 4.To enhance staff’s knowledge and skills in assisting toileting for fall risk patient
Methodology :
Proactive Toileting Training Programme (PTTP) aimed at promoting safe toileting practice to patients with fall risk. Target participants were 1) walk unaided with fall risk 2) walk with one assistant under supervision 3) deterioration of mental & physical condition. Purposeful toilet rounding was performed for target participants before napkin round for dependent patients to meet their elimination needs. Knowledge and skill transfer (arm reach length assistance and escorting skill) in form of training workshop were provided to staff. Staff were trained to conduct an encouraging statement to prompt patients for safe toileting to ensure privacy and dignity. Poster of PTTP was designed and displayed in clinical area for patients. Post intervention staff questionnaire was done to evaluate the effectiveness of PTTP.
Result & Outcome :
The total fall incident rate was decreased from 0.27 to 0.19 after 12 months PTTP implementation. Toilet-related fall incident was decreased from 7 to 0 that was significantly decreased by 100% when compared data 12 months before PTTP. Post-questionnaire was done among staff with over 95% staff reflected that PTTP increased their safety awareness and alertness on patient toileting. Furthermore, over 95% staff reflected that PTTP increased their understandings towards patient’s toileting needs. As a result, PTTP was effective in reducing toilet-related fall incident and should be integrated into existing nursing practice.
