Falls management in acute care

Louise BrentLead nurse for the Trauma and

Orthopaedic Programme & Irish Hip Fracture Database

• 130,000 older people fall annually

• 80% non-injurious / 20% follow health care trajectory

• Estimated annual cost of €404,000,000

• 2004: CSO – 297 deaths attributable to falls

• Irish inpatient falls; data lacking

Incidence

Causes of falls in the acute hospital

Recipe for falls and fracture prevention

Ingredients:• 1 Multidisciplinary group • A dash of enthusiasm• 1 Falls risk assessment tool• 1 Falls policy• A Sprinkle of audit• A Symbol to identify falls risk• 1 Education programme• 1 Strategy for bone health• 1 Patient information leaflet• 1 Falls awareness poster

Falls Policy

• Falls Prevention PolicyIdentification of the patient at risk of falling

(FRAT)Care Planning for those at risk of fallingInterventional strategies to prevent fallsProcedure to follow when a patient fallsAction plan following a fall

What to do when a patient falls

Falls information

Signage

Spread the word

Patient white board (name board)

Safety Cross

Fall Prevention ProgrammeSuccessful falls prevention programmes have the

following elements:

Leadership support Front line staff engaged Multidisciplinary committee Pilot testing interventions- Safety Cross, Intentional Rounding Use of IT to provide data about falls Staff education & training Convincing staff that falls can be prevented.

In-depth assessment• Medication review• Full medical review• Cognitive assessment• Assessment of vision• Referral to PT & OT• Exercise programmes (NH)• Mobility aid in reach?• Limiting tethers (lines, catheters)• Continence assessment (?toileting intervention)• Discharge planning• Bedrail risk & benefit review

Restraints

• No evidence that restraints reduce fall injuries

• Bedrails NOT safe in mobile patients • Restraints increase morbidity and may cause death

– Reported strangulation deaths from restraints every year– Risk factor for delirium, decubitus ulcers, malnutrition,

aspiration pneumonia

Alternatives to restraints

• Accept the risk of falling• Hip protectors• Environmental modifications, day rooms, low beds• Least restrictive alternatives• Alarms – no convincing evidence. “False positives”

generally annoy patient and staff• Sitters or family• Geriatric consultation team

LeadershipLeadership Frontline staffFrontline staff

• Establish a multidisciplinary falls prevention group

• Monitor & measure– Expect slow delivery of

improvement– DO NOT PANIC if there is a

“blip”• Train and develop staff• Create a safe environment

• Clear post-fall protocol• Risk stratify – high risk patients

for in-depth assessment• Ask about falls on every

admission• Avoid unnecessary

hypnotic/sedative medication• Ensure footwear appropriate• Ensure call bell within reach

Institutional approach to falls

To register contact amandawilkinson@rcsi.ie

Call for abstracts open until 9th October