Inpatient falls prevention: state-wide survey to identify variability in Western Australian hospitals

Abstract

Objective: A point prevalence survey was conducted across Western Australia to monitor adherence to evidence-based practices to prevent falls in hospitals. Study design and methods: A state-wide point prevalence survey of patients and their medical records was conducted across 20 hospitals, over 17 days during May 2014. The survey determined rates of: provision of verbal information to patients; completion of a falls risk screening tool and age based cognitive testing. Univariate and multivariate logistic regression was utilised to determine key risks and opportunities to improve. Results: Information was collected from 2,720 patients. The provision of verbal information to prevent falls, as recalled by patients was 60% (hospital range 35–88%). This was significantly higher for patients with a stay of six or more days or involved in rehabilitation care. Perinatal women were three times less likely to be provided with verbal falls prevention information. A falls risk screening tool was completed for 82% of patients (range 28–98%). Perinatal women, and both adult and paediatric patients compared to older adults, were significantly less likely to have a complete falls risk screening tool. Thirty seven percent of patients within the recommended age ranges had cognitive testing (range 0–87%). Short-term patients and those not involved in rehabilitation, were significantly less likely to have been tested. Discussion: The survey identified differences in patient care and supporting processes across all hospitals. The results have highlighted areas for improvement. Conclusion: There were wide variations across all the hospitals in the provision of falls information, completion of falls risk screening tools and cognitive testing. At significant risk of missing out on falls prevention strategies were short stay patients and perinatal women. Five hospitals had significantly low rates of cognitive testing, indicating a hospitalwide issue rather than specific patient cohorts. Subsequently, the importance of ensuring that falls prevention strategies are conducted is vital to reduce preventable inpatient falls in all care settings. Implications for research, policy and practice: This was the first state-wide point prevalence study in WA and it has informed the need for further research into the implication of falls risk inpatients. It was found that falls risk assessment was not conducted for each patient who met the screening criteria. A review of the criteria, and practicability to carry out the assessment may need to be further investigated to determine if the practice should be refined. What is already known about the topic? Falls in hospitals are a frequent and largely considered preventable health concern. Falls that occur in hospitals are associated with an increased length of stay and use of health resources. What this paper adds: This paper offers a comprehensive insight into the variation in hospital falls prevention strategies, from a state-wide perspective. It also identifies perinatal women as a high-risk group who are missing out on falls prevention strategies despite having the potential to fall. It also gives an insight to health services that not all at risk patients are being screened and those screened are not screened early in their inpatient stay which can be a risk to both patient and staff.