73 * INTERVENTIONS TO PREVENT FALLS IN AN INPATIENT HOSPITAL SETTING

Abstract

Background: Falls in hospital are extremely common and responsible for the greatest number of patient safety incidences reported to the NPSA (2004/2005: 60% of all reported incidents). The average cost-per-trust is £92,000 annually with additional physical and psychological stresses to the patient, coupled with the relative paucity of information surrounding falls in a hospital setting. We believed it of great importance to highlight areas of practice that are failing recurrent fallers and to identify effective intervention to prevent (not manage) falls. Search method: Retrospective notes review of 10 randomly chosen recurrent fallers identified from incident forms. Objective measures (Number of comorbidities; identification of risk; fall care plan completion) in addition to identification of recurrent themes for falling where effective intervention could be targeted. Results: Average age of patients was 85 [72-98] with average length of stay of 51.5 days (18-75). Average number of falls per patient was 7.6 (2-15), 90% patients had presented to hospital with a fall and 100% had >3 comorbidities (60% with dementia), yet despite this 40% were not highlighted as at risk of falling during their initial assessment. The leading theme for recurrent falls was a lack of observation: seldom were falls witnessed and understaffing on wards filled with high risk patients resulted in constant vigilance being an unachievable objective. An over emphasis was placed on the use of such preventative measures as call-bells that do not translate to patients with cognitive impairment. Conclusions: All elderly patients admitted to hospital should be assumed to be at risk of falling and fall care plans should be completed. To improve falls prevention in older people, it is important to undertake a risk assessment on admission and to highlight those at high risk. Additionally, improved staff distribution throughout the ward is needed so a nurse is available in each ward.