26 March 2012
A multi-faceted strategy to reduce in-hospital falls is being implemented at Waitemata DHB.
Led by Gerontology Clinical Director Dr John Scott, the approach recognises that there is no single ‘magic bullet’ to falls prevention but that a range of interventions can have a significant impact over time.
The Waitemata action plan targets older patients due to their greater potential for falls and increased fragility that often results in more serious injuries.
“Like all DHBs, we’ve known we have a problem with falls for a long time but there was no specific focus until mid-to-late 2010,” Dr Scott said.
“This is not a problem that is unique to us but we’re a big DHB and there is a healthy recognition we must take a leadership role.”
Dr Scott said the importance of taking action on falls reduction was highlighted by the fact that older patients who fall and break a hip face a 20 per cent risk of dying within six months due to issues associated with loss of mobility and independence.
Implementation of the falls reduction strategy has seen the appointment of a quality improvement specialist and involves:
• Signage aimed at patients spelling out how to reduce their risk of falling
• Equipment interventions such as non-slip socks and hip protector pads
• Close care for confused patients
• Review of medication to reduce the risk of falling
• Review of fall incidents
• Implementing new policies around toileting
• High-visibility triggers for staff – such as bold stickers on charts – to alert them to patients who are at high risk of falls
Dr Scott said the approach borrowed from international studies, consistently demonstrating that a package of interventions along the patient pathway is what reduces fall rates rather than a single headline initiative.
“It would be nice to say the problem has gone away but we cannot, unfortunately.
“There is no quick-fix. Even the best units in the world still have falls and this is an issue that still needs their ongoing attention.
“We haven’t seen dramatic reduction in our falls rates yet. A lot of these interventions take time to roll-out and it is also about staff education.
“One of the cultural messages we are working hard to send out is that general medicine staff, particularly nurses and charge nurses, must understand that looking after frail older people in the hospital is core business for them, too – not just gerontology staff.”
From 2010 to early 2011, Waitemata DHB recorded 13 cases of broken neck-of-femur as a result of inpatient falls.
Dr Scott said patient falls are potentially painful and emotionally-damaging experiences but each case presents an opportunity to learn and build new protections into the system.
North Shore Hospital’s review of fall incidents found a case of one elderly patient who fell three times before breaking her hip on the fourth occasion.
“There were three missed opportunities to intervene. These are the sorts of alarm triggers we are focusing on picking-up and responding to.
“We need to be paying particular attention to those patients who have already had falls in the past because they are at high risk of falling again.”