Jan Nicholson and Ken Stewart from Canterbury District Health Board (DHB) presented on their two falls projects at the recent Quality and Safety Challenge Forum held in Wellington. The projects ‘Falls reduction’ and ‘Real time data gathering of factors associated with falls’ were implemented at the DHB with the help of funding from the Health Quality & Safety Commission.
The studies were aimed at ensuring the elements of the Canterbury DHB falls prevention strategy were being implemented and documented in the clinical record, as well as determining if there was any variation between what was being documented and what is occurring.
The study focussed on screening for falls at every admission, identifying patients at risk of falling and documenting findings in the clinical record.
“We also wanted to determine if there was an opportunity to generate patient stories that reflect the key elements of fall management, and see if the nurses involved in the study could identify improvement activities,” says Ms Nicholson.
When a patient had a fall, there was a process to implement including collecting information about the incident as soon as possible after a fall, interviewing the patient, family, caregivers and staff, and comparing data with the clinical record. “We wanted to compare independent data collection with the clinical record and with information obtained from interviewing the patient and their family.”
Eight wards were identified to work in, and 233 falls were reviewed over a four-month period, with a total of 154 individuals who fell.
The study found that 91 percent of people who fell had been screened for falls risk on admission to the ward. In 88 percent of cases a falls risk assessment had been completed prior to the first fall, however falls risk assessments were renewed in only 56 percent of cases.
“Our results suggest that falls prevention strategies were often in place but some were inconsistently implemented and recorded in the clinical record. In many cases patients and families had a poor understanding of falls risk and the strategies in place to manage risk,” says Mr Stewart.
“The study has helped raise awareness in our hospital of the importance of having clinical records that closely reflect assessment findings and strategies in place.”
The study had also highlighted the need to improve the engagement of patients and families in falls management. A large part of the role of the study nurse was the transfer of best practice in falls prevention knowledge across a range of hospital wards. The study has highlighted the value of establishing the nurse falls champion role.