Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Ho YLE (1), Woo LC (1), Lam PL (1), Cheung KW (1), Leung WK (1), Tong KY (1), Chan WK (1), Huang CH (1), Or LY (1)
Affiliation :
(1) Disabled Unit, Cheshire Home Shatin
Introduction :
Cheshire Home Shatin (SCH), Disabled Unit (DU), provides care for two groups of patients: long-stay disabled residents and convalescence rehabilitation (CR) patients. To alleviate the bed shortage situation at Shatin Hospital (SH) and Prince of Wales Hospital (PWH), SCH initiated an annual plan to convert 40 infirmary beds to CR beds in two phases, starting from October 2021.
The first group of patients includes long-stay residents with severe disabilities who rely on wheelchairs and experience age-related decline in physical and cognitive function. They often overestimate their own capabilities to perform daily activities, increasing the risk of falls. The second group comprises patients with cognitive impairments, such as dementia and delirium, which present unique challenges to the nursing team and require a transformation of the care model.
Consequently, there has been a significant increase in the fall rate from 0.16 to 0.18 per 1000 patient days between 2021 and 2022. Analyzing the fall data revealed that most falls occurred among CR patients, particularly between 21:00 and 23:00, and commonly near the bedside. In response to these findings, a nursing improvement program has been implemented to prevent fall incidents in the DU.
Objectives :
1.To prevent patient falls and reduce the fall rate by 30%.
2.To enhance patient safety
Methodology :
A nursing improvement program was implemented, which included patient education, staff training, and revisiting the safety ward round. Patient education involved conducting fall risk assessments on admission, Day 1, weekly, and as needed. High fall risk patients received fall video education, which was repeated using Temi or portable VCD players. Staff training consisted of three sessions of staff refresher training courses held in April 2023. These courses covered various assessment tools such as the Abbreviated Mental Test, Modified Up and Go Test, and Care Bundle Model. The training aimed to ensure accurate fall assessments for patients and educate staff on the proper usage of preventive accessories. To enhance the patrol system, a safety ward round was implemented. Designated nurses or supporting staff performed regular patrol rounds during each shift, following a checklist of 7 items. This included checking dentures, alarm pad function, reachable call bell, bedside rails, hip protectors, restraints, and assisting patients with toileting. Additionally, communication between night shift nurses in pair wards was established to perform separate rounds for diaper changes and ensure one staff member available for patrol rounds in each ward.
Result & Outcome :
There was a significant decrease in the fall rate from 0.18 in 2022 to 0.07 in 2023 after the program was implemented. These results indicate that the program effectively improved nurses' ability to assess fall risks and implement prevention measures in the ward. Consequently, the number of fall incidents decreased significantly.
