Falls Prevention and Management in a Hospice In-Patient Unit: Evidencing Best Practice and Documentation

Background1. Falls prevention and management was integral to care in the Hospice but was not

well evidenced. 2. Documentation of falls risk assessment, prevention and management was

inconsistent3. Staff awareness of falls risk assessment, prevention and management was variable.

Aim• Toevidencebestpracticeanddocumentationforfallsriskassessmentand

management

What did we do? • Identifiedariskassessmenttoolforfalls• Developedacareplanforfallspreventionandmanagement• Identified10qualitystandards

How did we implement this?• Deliveredpractice-basedlearningforallnursingstaff• Pilotedtheriskassessmentandcareplaninoneofthenursingteams• Adaptedthecareplan• Implementedacrossthewholeward• Supplementaryeducationonfallsretrievalforallnursingstaff• IntegratedtheriskassessmentandcareplanintoE-healthrecord(Crosscare)• AdaptedthegenericIncidentReportingFormstocapturefallsriskassessmentand

fall prevention

Audit• ConductedanAudittomeasurecomplianceoneyearafterimplementation• Datawascollectedprospectivelyfor40consecutivepatientsadmittedtoIn-patientUnitbetweenFebruaryandApril2015.

• Eachcasewasfollowedforaneightdayperiod.• Compliancewasmeasuredbyreviewingdocumentationandobservingpractice.

AuditResults

OverallImpact• Theprogrammeoffallsriskassessmentandmanagementisembeddedinthe

process of care.• Staffareawareandproactiveaboutassessing,preventingandmanagingfalls• Documentedevidenceofthiscanbeconsistentlyfoundinthehealthrecord

Next Steps• Improveareasoflowercompliancewithstandards• Developfalls‘champions’acrossthenursingteam(trainedanduntrained)• IdentifytheextenttowhichtheFallsAssessmentandPreventionProgrammehas

reduced the number of falls.• Explorebestpracticeformanagementofspecificriskfactorsi.e.Delirium/cognitivedeficits

Jean Gow 1,ElaineMcManus2,MarjoryMackay 3 1Physiotherapist,StrathcarronHospice; 2PracticeEducator,StrathcarronHospice3 Director of Nursing, Strathcarron Hospice.ContactDetails:jean.gow@nhs.net

Standard 1. Allfallsriskassessmentwillbecarriedoutforall 100% patientswithin24hoursafteradmission. 2. Allfiveindividualriskareasintheassessmenttool 85%

willbecorrectlyidentifiedforallpatients. 3. Everypatientwillhavetheirriskassessedweekly. 95%

ComplianceAll40patients

4. Allpatientswithafallsriskscoreof2ormore 85% will have a falls prevention care plan initiated on thedayofadmission.

14patientswereidentifiedtobeatriskoffalls

5. Allpatientswithascoreof2ormorewillhave 75% theircareplansrevieweddaily. 6. Thecareplanwillidentifyinterventionswhich 92% reflect individual risks. 7. Thereisevidencethatallidentifiedinterventions 92% have been implemented.

8. Everypatientwillbere-assessedforfallsrisk 100% following a fall. 9. Everypatientwillhavethecareplanreviewed 100% following a fall. 10. Anincidentformwillbecompletedwithin24 100% hours for all patients who fall.

12ofthe14patientshadaFallsCarePlan

3 of the patients fell during the audit period