A multi-cycle, multi-intervention QI Project improving the immediate assessment of inpatient falls

Introduction

Inpatient falls have the potential to result in significant morbidity.  This is especially true in our cohort of older patients. There is a wide variability in the levels of confidence levels amongst nursing and medical staff when it comes to the immediate assessment following a fall. The aim is to ensure that there is a safer and more consistent approach to the above.  This project has acted as a ‘start-up’ for a larger Spread & Scale across the Health board. However, we will focus on University Hospital Llandough for the purposes of this QI.

Method

Baseline data was collected during a one-month period in 2021, using the hospital DATIX system. The key points we looked at were: immediate assessment for high-risk injuries (before moving patient), appropriate immobilisation, manual handling methods and then documentation of an A-E assessment.

What followed was a multi-cycle QI, with interventions based on need. Our interventions included 1. Introduction of a formalised ‘Falls proforma’, 2. Dedicated SIM sessions for Resident doctors, 3.  Roll out of ‘Action cards’, 4. Dedicated training sessions for Nursing colleagues.

The above data was recollected at distinct intervals, following the roll out of these interventions.

Results

56 inpatient falls were reviewed.  Immediate review for high-risk injuries improved from 17.4% in 2021, to 52% and then 75% in 2024. 0% of patients in 2021 were ‘immobilised’ until medical review, which improved to 20% of those with ‘high risk features’ on post-intervention cycles.  Documented A-E assessment also improved from 17.4% at baseline, to 32% and then 87.5%.

Conclusion

This QI has shown a sustained improvement in the above domains, suggesting change is becoming embedded. We aim to repeat the cycle, to ensure long term improvement. We are also in the process of ‘Spread & Scale’ across other hospital sites in the Health Board.