Educating nurses to prevent falls on hospital wards

Published on Tuesday, 17 July 2012 11:01
Written by Vicki Mitchem

The FallSafe project involved educating, inspiring and supporting acute, rehabilitation and mental health nurses to deliver multifactorial assessments and interventions through a care bundle approach.

The care bundle, the FallSafe project final report, and How to... guides for implementation comprise the Falls Prevention Resource pack, which launches today.

Over 280,000 patient falls are reported from hospitals and mental health units annually, costing approximately £15 million per annum. Most hospital fallers are aged over 75 years and have multiple long term and acute illnesses. Although in purely financial terms the healthcare costs of falls are only a small fraction of a percentage of trust income and expenditure, the costs to a trusts' reputation, patient and carer confidence, and social care costs can be significant.

The FallSafe project was delivered by the Royal College of Physicians (RCP) as part of the Health Foundation's Closing the Gap Programme, which aimed to reduce the gap between best practice and routine delivery of care. Although all falls cannot be prevented without unacceptable restrictions to patients' independence, dignity and privacy, research has shown that falls can be reduced by 20-30% through multifactorial assessments and interventions.

The main mechanism of improvement was supporting a designated nurse – a FallSafe lead - to lead local improvement on their own wards, influencing not only the ward nurses and healthcare support workers but also their physiotherapist, occupational therapist, pharmacist, and medical colleagues.

Dr Frances Healey, a registered nurse who was clinical co-lead of the fallsafe project, and associate director, RCP's Clinical Effectiveness and Evaluation Unit, said:

'The FallSafe project is a great illustration of how quality improvement can empower and inspire nurses to lead and drive change on their wards, influence a multidisciplinary team, and deliver better patient care.

'The 16 nurses, who rose to the challenge of FallSafe lead within their wards, demonstrated that they can be effective change agents. This is an important finding given more senior staff may not have the capacity to lead quality improvements in the areas where it is needed. The FallSafe leads grew in confidence, knowledge and skills and, by the end of the project, felt that attitudes to falls prevention on their wards had been 'transformed' from passive acceptance to active engagement in falls prevention.'

Dr Adam Darowski, consultant geriatrician, and clinical co-lead for FallSafe said:

'Avoiding medication that can increase the risk of falling is a vital part of falls prevention. FallSafe proved how much nursing staff can influence doctors' prescribing practice – the FallSafe leads provided educational materials to the doctors on their wards, requested medication reviews for hundreds of patients, and by the end of the project the number of patients being given night sedation had reduced by 41%.'

Jill Phipps, clinical specialist physiotherapist & falls prevention coordinator at Southern Health NHS Foundation Trust said:

'Many hospitals don't have a process for issuing mobility aids to new patients except on weekdays when physiotherapists are on duty; but by the end of the project most of the FallSafe wards had arranged for mobility aids to be provided by trained nursing staff  on a temporary basis  as soon as they were needed. This was a great example of how nurses and physiotherapists can work together on sharing skills and experience to improve patient's mobility and reduce the risk of falls.'

The report indicates FallSafe wards and their hospitals have benefited through substantial improvements in the proportion of patients receiving multifactorial assessments, changes to policy, attitude to and awareness of falls, and better team working. FallSafe delivered a 25% reduction in falls for the South Central area and it is anticipated there will be further reductions as the project is rolled out to other hospitals. The costs of delivering the FallSafe project were kept low enough for its replication on a wide scale to be feasible, and the mix of ward types involved demonstrate that it could be replicated in most hospital settings.

Source: ©RCP

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