A RETROSPECTIVE AUDIT OF DOCUMENTED FALLS IN GERIATRIC PATIENTS IN THE GENERAL MEDICINE WARD OF A TERTIARY HOSPITAL Deo D., Tan T., Chee J., Ng Y.J.
Documentation Inconsistency
Background
Results
There is a strong association of morbidity and mortality of injuries related to falls in older people. In New South Wales (NSW) Australia, falls lead to approximately 27,000 hospitalizations and at least 400 deaths each year in people aged 65 years and over. (1)
‣ 37 inpatient falls across 31 patients
Aim of study
-
To evaluate the effectiveness of current risk assessment and screening criteria for falls risk in use by John Hunter Hospital, Newcastle, NSW, Australia in preventing an inpatient fall To identify additional high falls risk factors that could be used to supplement the existing protocols in place, using screening tools such as the Morse Fall Score
METHODS
-
A retrospective audit of patients admitted to the medical ward between July 2018 and July 2019 Each patient had one or more inpatient falls during their admission during the period of analysis Data was taken from their Ontario Falls Risk Screen (Ontario), Falls Risk Assessment and Management Plan (FRAMP), discharge summaries and other relevant notes in patient records Descriptive statistical analysis was undertaken
Number of Patients
30
27
18 12 6 0
15 16
‣ 33% of patients had a positive Falls Risk Assessment and Management Plan (FRAMP), but no falls risk sticker
‣ 10% of patients had neither a FRAMP chart filled nor a falls risk sticker
20
Positive FRAMP Negative Sticker
33%
50% Positive FRAMP Positive Sticker
Mental Status
Dementia and Delirium
16%
‣ For 50% of patients it was done correctly
Conclusion
10% 7%
‣ 7% of patients had no FRAMP chart filled but a falls risk sticker was placed
35%
Normal Cognition
19%
‣ Inpatient falls is a significant cause of increased patient morbidity and mortality. It warrants that efforts be made to minimise this where possible and several areas where improvements to the existing system can be made were identified
Non-Modifiable Risk Factors 24
‣ 30 out of 31 patients had an identified falls risk in their Ontario Falls Risk Screen (Ontario). For 50% of the patients this was not followed through
Negative FRAMP Negative Sticker
Negative FRAMP Positive Sticker
Dementia Delirium
29% Normal Cognition Dementia
Falls Risk Factors
11
Male
4
Previous history of falls
Delirium Dementia and Delirium Reference ‣
Use of walking aids
Polypharmacy
Delirium +/Dementia
1. Population Health Division. Sydney: NSW Department of Health. The Health of the people of New South Wales – Report of the Chief Health Officer, Data Book – Injury & Poisoning; 2008.
Acknowledgements
Hospital False Delirium Incomplete Weekends Documentation Toilets Screen
Mobilisation
‣
Dr. B. Walsh, Head Geriatric Medicine, University of Newcastle
‣
Merridie Rees, John Hunter Hospital