Don’t fall for it, follow the steps!

Post falls assessments are attended by nurses after patients have a fall in the St George Hospital emergency department (ED). This will improve and benefit patients and their journey by:

• identifying medical concerns
• decreasing patient morbidity and mortality
• decreasing the length of patient stays within St George hospital
• preventing further falls.

This assessment can also have a secondary positive effect on patients, their families and carers as it can highlight areas of health concerns and promote education for carers and families.

Aim

By December 2018, to increase compliance of the completion of the post fall assessment within St George ED by 60%.

Benefits

By improving post fall assessment compliance in this project, it will benefit the clinical unit, the organisation, local health district and key stakeholders. It will do this by:

• reducing the patients’ length of stay in hospital
• reducing patient morbidity and mortality
• improving service delivery within St George Hospital
• reducing hospital costs, including the annual amount of government funding allocated to falls prevention, through increased compliance in
• post fall assessments being properly completed.

It will also result in:

• increased falls preventions mechanisms in place for high risk falls patients
• increased awareness and knowledge from staff of procedures when filling out post fall assessments
• possible reduction in falls within the emergency department
• increased awareness by ward staff at the handover of patients who have a high falls risk, which leads to better allocation of resources on the clinical floor
• better multidisciplinary input for patients and their families prior to discharge
• better patient education to prevent the fall occurring.

On a broader level the following benefits exist.

• The assessment can help identify medical concerns that may not have come to light. This can also help healthcare professionals in the multidisciplinary team to plan the best care for the patient, their carers and families when returning home.
• From a workforce point of view, by working in a busy environment, involving key stakeholders and improving the patient journey through hospital, it can also prevent falls from occurring.
• It is also hoped that by improving compliance with the post fall assessment form that the improvement can be sustained in the clinical area and eventually spread through the organisation.

Background

Between May to June 2018, nine patients had a fall within the ED during their admission. Reasons for each patient falling were multifactorial.

The post fall management of these patients was not followed, as per the South Eastern Sydney Local Health District Clinical Business rule (Directorate of Planning 2017). An informal anonymous survey was then sent to the St George ED staff to gauge their knowledge and understanding of what is required after a patient falls within the ED.

The results showed that there is a significant lack of knowledge regarding what to do. This project aims to enhance quality of care and patient safety in response to these findings.

Implementation

• Team meetings to brainstorm ideas and develop driver diagram and drivers.
  • Ideas were sorted into driver groups.
  • Primary and secondary drivers were developed and measures were devised. The primary drivers included increasing education and knowledge and decreasing environmental factors impacting on the clinical staff. Change ideas that supported this included developing a resource folder for the clinical floor and education sessions.
  • Solutions were devised, including change concepts.
• Three plan-do-study-act (PDSA) cycles were implemented and evaluated.
• Education sessions were developed to describe the requirements for a post falls assessment. This session was implemented and run over a three month period. A pre-implementation questionnaire was also sent to staff to gauge to general knowledge on this issue. Post education session feedback has been requested by staff.
• A lanyard was created, displaying a flow chart of what is required after a fall.

Status

Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.

Dates

• June 2018 – Project starts.
• October 2018 – Start first PDSA cycle.
• December 2018 - Preliminary evaluation. This involved collecting data (similar to the data collected initially) to see if a difference has been made. It also allowed for changes to be made to the education presentation if required, depending on the feedback given.

Implementation site

St George Hospital emergency department

Evaluation

• An audit will take place in November 2019, after two of the three solutions (PDSA cycles) have been rolled out and had the opportunity to make a difference.
• The Incident Information Management System (IIMS) reports provide useful insights, given they review what procedure was followed and what was completed after a patient has a fall within the emergency department. This includes looking at the post-fall management form that is to be filled out by staff, assessing the vital signs recorded and reviewing documentation by medical and nursing staff in the patients’ notes.
• Another audit took place January 2019 when all PDSA cycles were implemented. The PDSA cycles will be measured by asking for anonymous feedback from staff who are involved in receiving the education sessions and /or use the implemented folder.

Lessons learnt

• Be prepared to invest time in people who do not support the idea or are difficult to engage.
• Change the presentation to suit the facility you are trying to engage with, so that it is  pitched appropriately to your audience.

Further reading

• South Eastern Sydney Local Health District. Falls prevention and management for non-admitted patients. SESLHD: 2023.
• Clinical Excellence Commission. Preventing falls and harm from falls in hospital. CEC: 2013.
• Clinical Excellence Commission. SMART AIM statement. CEC.

Contacts