Falls management in acute care settings requires a multidisciplinary approach. A successful falls prevention program has leadership support, frontline staff engagement, a multidisciplinary committee, pilot testing of interventions, use of data to monitor falls, staff education and training, and convincing staff that falls can be prevented. When a fall occurs, the policy should include risk identification, care planning, preventative strategies, procedures to follow, and action plans. Risk assessment tools, policies, education, signage, and patient information can help reduce falls and their costs on the healthcare system and patients.

1. Falls management in acute care
Louise Brent
Lead nurse for the Trauma and
Orthopaedic Programme &
Irish Hip Fracture Database

2. • 130,000 older people fall annually
• 80% non-injurious / 20% follow health care
trajectory
• Estimated annual cost of €404,000,000
• 2004: CSO – 297 deaths attributable to falls
• Irish inpatient falls; data lacking
Incidence

3. Causes of falls in the acute hospital

4. Recipe for falls and fracture prevention
Ingredients:
• 1 Multidisciplinary group
• A dash of enthusiasm
• 1 Falls risk assessment tool
• 1 Falls policy
• A Sprinkle of audit
• A Symbol to identify falls risk
• 1 Education programme
• 1 Strategy for bone health
• 1 Patient information leaflet
• 1 Falls awareness poster

5. Falls Policy
• Falls Prevention Policy
Identification of the patient at risk of falling
(FRAT)
Care Planning for those at risk of falling
Interventional strategies to prevent falls
Procedure to follow when a patient falls
Action plan following a fall

6. What to do when a patient falls

7. Falls information

8. Signage

9. Spread the word

10. Patient white board (name board)

11. Safety Cross

12. Fall Prevention Programme
Successful falls prevention programmes have the
following elements:
 Leadership support
 Front line staff engaged
 Multidisciplinary committee
 Pilot testing interventions- Safety Cross, Intentional Rounding
 Use of IT to provide data about falls
 Staff education & training
 Convincing staff that falls can be prevented.

13. In-depth assessment
• Medication review
• Full medical review
• Cognitive assessment
• Assessment of vision
• Referral to PT & OT
• Exercise programmes (NH)
• Mobility aid in reach?
• Limiting tethers (lines, catheters)
• Continence assessment (?toileting intervention)
• Discharge planning
• Bedrail risk & benefit review

14. Restraints
• No evidence that restraints reduce fall injuries
• Bedrails NOT safe in mobile patients
• Restraints increase morbidity and may cause death
– Reported strangulation deaths from restraints every year
– Risk factor for delirium, decubitus ulcers, malnutrition,
aspiration pneumonia

15. Alternatives to restraints
• Accept the risk of falling
• Hip protectors
• Environmental modifications, day rooms, low beds
• Least restrictive alternatives
• Alarms – no convincing evidence. “False positives”
generally annoy patient and staff
• Sitters or family
• Geriatric consultation team

16. LeadershipLeadership Frontline staffFrontline staff
• Establish a multidisciplinary falls
prevention group
• Monitor & measure
– Expect slow delivery of
improvement
– DO NOT PANIC if there is a
“blip”
• Train and develop staff
• Create a safe environment
• Clear post-fall protocol
• Risk stratify – high risk patients
for in-depth assessment
• Ask about falls on every
admission
• Avoid unnecessary
hypnotic/sedative medication
• Ensure footwear appropriate
• Ensure call bell within reach
Institutional approach to falls

18. To register contact amandawilkinson@rcsi.ie
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October