Falls prevention in Gunyah, a neurology and oncology ward in Sutherland Hospital

This project is designed to improve falls prevention in a medical ward in an acute care facility. It identifies the causes of inpatient falls to provide strategies in response.

Aim

To decrease the number of falls by 50% by 31 December 2018, compared with 11 falls in July 2018.

Benefits

For patients

• Prevent injuries that are caused by falls.
• Produce positive patient outcomes.

For nurses

• Provide more education on falls prevention to facilitate better risk management.
• Provide more education on falls prevention to assist nurses to provide high-standard patient care.

For the facility and healthcare system

• Create cost saving for the healthcare system.
• Lower incidence of fall related injuries and related complaints.
• Reduced patient length of stay.

Background

There were 11 incidents related to falls in July 2018 on Gunyah ward, which was the top incident type for the month. Falls incidents led to poor patient outcomes and involved more investigations or treatment for patients. Nursing staff experienced frustration regarding the number of patient falls, and wanted a better solution.

Implementation

Ensured a safe environment for patients

• Developing a safe environment checklist, including footwear, night lights, low bed, no bed rails, delegated falls rooms and so forth.
• Discussing this checklist within the project team and with the nurses.
• Seeking feedback on the checklist, which revealed that while the checklist was easy to read and follow, it overlapped with the ‘environment’ section in the Falls Risk Assessment and Management Plan (FRAMP), which is the current documentation.
• Deciding to continue with the current FRAMP, while also encouraging nurses to check every patients’ environment against the checklist.

Increased awareness

Increased the awareness of patients’ falls risk status via multiple communication methods.

• Using patients’ bedside boards to identify their fall-risks and mobility status.
• Highlighting patients who are at a high falls risk and discussing their management plans in group handovers, safety huddles, and clinical handovers.
• Auditing the use of bedside boards, clinical handover and safety huddles to inform the management plan for patients with high falls risk scores.
• Increasing staff awareness around these methods to help support the management of high fall-risk patients in ward meetings, via email, and also in falls prevention education sections.

Increase staff education

• Developing new education sessions and regular education programs for falls prevention, which include ‘Falls November’ on Gunyah and regular falls prevention in-services every second month, led by the clinical nursing educator.
• Auditing staff's attendance at these education sessions, as well as the compliance of fall assessment and post-fall assessment on the electronic medical record.

Status

Sustained – The project has been implemented and is sustained in standard business.

Dates

20 August 2018 to 31 December 2018

Implementation site

Gunyah ward at Sutherland Hospital

Partnerships

Clinical Excellence Commission Clinical Leadership Program

Results

• The number of falls incidents decreased by 73% in Gunyah between July to December 2018. The reduction went from 11 falls incidents in July 2018 to three falls incidents in December 2018.
• The compliance rate for completion of FRAMP within 24 hours of admission increased from 83% in July 2018 to 87% in December 2018.
• The falls prevention in-service covered 90% nursing staff on the ward during this project.
• The usage rate of the bedside board for ‘fall risk’ increased from 43% in July to 75% in December 2018.

Lessons learnt

• Brainstorm sessions with project members generate feasible solutions.
• Delegate tasks appropriately to project members to motivate team members and produce dramatic outcomes.
• Develop positive relationship with all stakeholders, such as consumers, to introduce other views on the project and possible solutions.
• Hold regular project meetings with a planned agenda to drive the project forward.
• Regularly monitor data and share information with the nursing staff on the ward, to assist with the implementation of the project.

Further reading

• Australian Institute of Health and Welfare, Cripps R, Carman J. Falls by the elderly in Australia trends and data for 1998. Canberra: AIHW: 2001.
• Mathers C, Penm R. Health system costs of injury, poisoning and musculoskeletal disorders in Australia 1993–94. AIHW cat. no. HWE 12. Health and Welfare Expenditure Series no. 6. Canberra: AIHW; 1999.
• Watson WL, Clapperton AJ, Mitchell RJ. The cost of fall-related injuries among older people in NSW, 2006-07. NSW Public Health Bull. 2011 Jun;22(3-4):55-9. doi: 10.1071/NB10002.
• Australian Commission on Safety and Quality in Health Care

Contacts