How can we Improve Multi-factorial Falls Assessments in Patients at Risk using Health Pathways and Other Measures?

How can we Improve Multi-factorial Falls Assessments in Patients at Risk using Health Pathways and Other Measures?

Background

All admitted patients require completion of a multifactorial falls risk assessment (MFRA) within 6 hours; in order to identify at risk patients and implement a care plan to aim to reduce the risk of falling.

Hospital Health Pathways have a ‘Falls prevention and risk assessment’ pathway which can be used to perform a multifactorial falls assessment.

Objective

We planned to evaluate how effectively we perform multifactorial falls assessments on the Older Persons Acute Medical Unit (OPAMU) at the University Hospital of Wales, using standards described in the NICE and WHO guidelines.

Method

We designed a data collection proforma which involved reviewing the MFRA and patient notes, gathering information against each standard. We then followed the ‘Falls prevention and risk assessment’ pathway for each of these patients ensuring any outstanding assessments/ interventions were completed.

Results

The MFRA was complete for all patients suggesting that 64% of patients were at risk of falling, however due to inaccurate completion it was re-calculated that actually 86% of patients were at risk of falling. The majority of patients had a cardiovascular examination, lying and standing blood pressure, 4AT, footwear review, ECG, medication review and CFS score completed. The areas of assessment that needed improving were bone health assessment and vision assessment.

Discussion

Our data suggests staff are consistently completing the MFRA, although the information was not always accurate and therefore patients were deemed not at risk inappropriately. We have identified a need for further staff education which we are currently initiating.

The subsequent use of the ‘Falls Prevention and risk assessment’ pathway demonstrated that this would prompt all sections of the assessment to be completed; we now include the checklist in the admission pack and residents are encouraged to use the pathway.

Our admission pack now also includes a Lying and Standing BP focussed chart, to facilitate accurate recording and a falls prevention leaflet, which is given to all patients. This project is ongoing and we are currently in our third PDSA cycle.