Improving Inpatient Falls Reviews at North Manchester General Hospital – A Local Quality Improvement Project

3331
Hannah Parry-Jones1
North Manchester General Hospital, MANCHESTER UNIVERSITY Foundation Trust
Clinical Quality
SP - Falls
Falls

Abstract

Introduction:​ Inpatient falls are a significant concern due to their impact on patient safety and outcomes. A standardised approach to reviewing falls can help identify contributing factors and improve care. Despite the recognised importance of fall reviews, inconsistent documentation and inadequate follow-up remain common challenges. This project aims to enhance resident doctors' reviews of patients after an in hospital fall, and improve their confidence and experience in responding to such calls. Ultimately it aims to determine contributing factors, and guide prompt investigation and management of fall sequelae.​ 

Methods:​ Relevant guidelines, including those from NICE, the Royal College of Physicians, the British Society of Geriatrics, BMJ Best Practice, and best practices from other trusts, were used to develop a proforma containing 15 key elements for a gold standard fall review.​ Cycle 1 data were collected by reviewing doctors' documentation of inpatient falls on the Electronic Patient Record system (EPIC) across six medical wards over a one-month period. Notes were analysed for the inclusion of each identified standard.​ An electronic smartphrase proforma was created based on the guidelines and distributed to doctors, emphasising the importance of thorough falls reviews.​ Data collection was repeated in the second cycle to assess the impact of the proforma, measured by the percentage inclusion of each key element in a sample of falls reviews.​ Additionally, feedback was collected from doctors regarding their experience. 

Results:​ Improvement was observed in the quality of doctors' falls reviews, with an increased proportion of key standards being included. This reflected more thorough examination, better consideration of factors contributing to falls, and more comprehensive investigation and management. Feedback from doctors indicated that the proforma was beneficial. 

Conclusion:​ The introduction of this proforma significantly improved doctors' approach to inpatient falls in the early stages of the project. Progress is needed to encourage universal adoption and further educate on the importance of comprehensive reviews for better patient outcomes.

Comments

Hello. Thank you for presenting your work. What reasons are there for not documenting medication / anticoagulant reviews or need for neurological observations?

Submitted by alasdair.macrae on

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The primary barrier is doctors not utilising the proforma smart phrase which, in our Electronic Patient Records, requires being aware how to input the pro forma in to the notes. This is aiming to be mitigated by teaching to all new doctors to the hospital. A further action to promote documentation of these parameters is to liaise with IT to create a note type which would mean any falls review would automatically input the pro forma to the note.

Probably the most effective way is to work with IT to make the proforma a note type; this would mean the note automatically includes the domains without the need for doctors to add the smart phrase themselves. Furthermore, within the smart phrase these domains could be made more prominent to reduce omission. Additionally teaching on falls reviews is ongoing for doctors new to the hospital which aims to improve inpatient falls reviews further.