Quality Improvement

Reducing harm

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Falls prevention II: zero falls with harm

Falls prevention II: zero falls with harm

What constitutes harm from a fall?

Falls frequently result in harm.  This can include:

  • death
  • a knock to the head causing concussion or a brain injury
  • a fracture
  • a dislocation of any joint
  • a cut requiring stitches
  • teeth or dentures chipped requiring repair or replacement

Value: With CompassionWhat did we find?

Following on from our initial Falls prevention programme [view more about the Falls prevention programme], we needed to better understand how, where and why falls with harm are happening in our hospitals.  To do this we need to look at all the information we have about patients who have fallen while under our care.

1. Is there any pattern to the time falls occur?

We looked at a ward with a high rate of falls with harm and found twice as many falls on the ward during the day compared to night.  There were also some specific times during the day when falls were more likely.

Falls by Time of Day Chart


2. Were falls with harm occurring at a particular time in a patient's stay?

Yes, over half occur within the first three days of admission.   (The average length of stay is just under 4 days (3.84 days).  Some patients can be in hospital for over 100 days)

Days Between Falls Chart


3. Who is most likely to fall and suffer harm?

We found that:

  • 58% had previous falls history
  • 94% were European
  • 68% were female
  • 83 years old on average
  • 44% live home alone before coming into hospital

4. What were the serious consequences of falls with harm?

We found that:

  • 45% suffered a fractured hip
  • 13% died while still in hospital
  • a further 5% died within 10 days of discharge
  • and a further 11% died within 30 days of discharge

5. Given how early in a patient's stay falls are occurring, are people being assessed early enough?Nursing Assessment Form

Falls risk was not being assessed in the Emergency Department (ED) nor in the Admission & Discharge Unit (ADU), meaning that risk was not being identified as early as it could be.  An opportunity exists to develop simple and quick assessment tools as part of an ED or ADU nurses workload.


Solution

Develop a simple tick box assessment tool for risk factors like falls, pressures and delirium as part of the nurses usual assessment form.


6. After assessing a patient's falls risk, what was done to prevent a fall occurring?

While staff reported using different strategies to prevent falls, it was difficult to see when and how they were being used.


Solution

Develop a second page to the current falls assessment tool that recommends and captures a care plan (different ways to prevent falls).

New Falls Assessment Form


7. Where do falls occur on the ward?

The current information in our reporting systems does not give us a clear picture of where falls occur. 

To help build a picture of where falls occur, all falls are to be marked on a ward map to see if any particular places are worse than others.  We are currently piloting the maps on a number of wards.

Falls Count Map for NSH ADU

Falls count map for North Shore Hospital ADU


8. Do falls happen all the time or are they sporadic?

The data we have tells us that the time between falls can vary from falls happening on the same day to weeks between falls.


Solution

To encourage staff to help patients not fall, a "days between" tracker is being piloted on a number of wards.  It has been shown to have a really positive effect in other hospitals where staff are motivated to make the days between as great as possible.


Where to from here?

This second falls project provided some clear insight into the falls that cause major harm and introduced some useful changes to the tools use to assess and manage the risk of falling.  The project did not, however, achieve its objective of decreasing major harm from falls.

We need to ensure reliability of the multiple changes we have made, including consistent and reliable falls risk assessments and care plans that correspond to the risk assessment and are tailored to the individual patient’ needs, before we implement and test any further change.  From October 2013, our senior nursing team will be leading our falls programme. 


What can you do to help us?

Find out more about how you can prevent falls while in hospital and at home:

Preventing falls brochure for patients and families
Preventing falls in hospital and at home brochure
[Download the preventing falls brochure]