Falls Assessment and Prevention in the Health and Ageing Unit (HAU) in a Large Central London Teaching Hospital Emma Lewin, Ruth Evans, Maitri Shila Tursini Harriet Howard
Background and Aims
Falls are a common hospital presentation in the ageing population, with 30% of over 65s and 50% of over 80s suffering with at least one fall a year. A fall can lead to negative physical and psychological sequelae and falls are estimated to cost the NHS more than £2.3 billion per year. NICE has produced guidelines advising on the multifactorial assessment that should be carried out in patients presenting to hospital following a fall in the community, in order to prevent subsequent falls in the future and further hospital admissions. The aim of this project is to evaluate how well the department at King's College Hospital was completing the multifactorial falls assessment as described in the NICE guidelines on falls prevention and identify specific areas for improvement.
Methods
A retrospective review of all inpatients, over the age of 65, admitted on a randomly chosen week into the Health and Patients were screened and included if they were identified as presenting with a fall or having a history of falls. Adherence to NICE guidelines for falls assessments was then checked. Clinical notes were reviewed for evidence of the following by any of the multidisciplinary team: eight specific multifactorial assessments gait assessment, FRAX score, medications review, visual assessment, cognitive assessment, home environment assessment, ECG and lying-standing blood pressure (LSBP), and whether done correctly) Four multifactorial interventions increased package of care or adaptation of home environment, vision referral or intervention, referral to strength and balance training (including community physio), medication changes
Interventions
In between the two audit cycles, the following interventions were put in place with the aim of improving multifactorial falls assessments: 1. Teaching session to share findings with the department, remind of the guidelines and give suggestions on how to improve assessments 2. Creation of posters to put up around HAU as a visual reminder 3. Creation of an electronic proforma to be used to aid falls assessments and ensure all elements completed prior to discharge 4. Survey of staff on HAU to identify barriers to completing the assessment
Results Cycle 2
Four interventions were put in place with the aim of improving the quality of falls assessments. The performance of the department was then re-audited for patients admitted in a random week in June 2021 following the interventions. The results were tested for statistically significant change using a chi square test.
Results Cycle 1
The data analysis demonstrated a completion rate of : >90% was demonstrated for ECG, assessment of home environment and medications review. <30% was demonstrated for lying-standing blood pressure, visual assessment and FRAX score calculation Therefore, teaching on how to perform these assessments and tips for making these easier were specifically including in a departmental teaching session. E.g. signposting to the Sheffield FRAX score calculator, teaching on how to perform a bedside vision assessment and lying-standing blood pressure correctly
Demographics
Cycle 1 Cycle 2
Patients admitted HAU Patients with falls history Male:Female Age range
80 52 20:32 69-102
Conclusions and Next Steps
87 53 25:28 70-100
Statistically significant improvements demonstrated in gait assessment (83% to 89%), visual assessment (29% to 36%) and FRAX score calculation (21% to 34%) All other areas improved or were unchanged, but with no statistical significance Statistically significant improvements demonstrated in intervention of adaptation of home environment The staff survey demonstrated the following barriers to completing a comprehensive falls assessment: Limited time available to complete assessments Lack of clarity on which member of the MDT was responsible for completing the different assessments Not having all the elements required to complete an assessment (e.g. Snellen chart for vision assessment, height and weight measurement for FRAX score) Lack of knowledge on how to perform and interpret certain assessments (e.g. performing LSBP, interpreting FRAX score)
An assessment for risk factors/cause should be done for all patients at high risk of falls or admitted with a fall followed by any interventions deemed necessary This project demonstrates how surveying staff can help us understand why certain aspects of our practice are not being carried out consistently and how continuous education can improve our care for patients Next steps include plan to establish project as a rolling audit to continue reviewing and overcoming barriers to falls assessments
