Abstract
Introduction
Inpatient falls remain a major healthcare challenge, with an average rate of 6.6 per 1,000 occupied bed-days in NHS England and Wales hospitals. Prevention of falls during hospital stay based on identifying and managing the modifiable risks are challenging. Multifactorial falls risk assessment and prevention action plan (MFRA FPAP) is a proforma booklet adopted by ABUHB.
Methodology
The initial QIP (2022–2024) revealed incomplete and poor-quality MFRA. Falls champions were introduced for a period of time, it showed an improvement, but was not sustained. Due to a rise in in-patient falls, the QIP was repeated. Eighty patients across three COTE wards were reviewed. Data collection included patient interviews, collateral histories, clinical notes, electronic systems (CWS), and GP records. Bone health was assessed using the FRAX UK score, and falls risk evaluated via MFRA, following NICE 2013 guidelines. We again identified ongoing gaps in MFRA and bone health. To address this, we introduced posters and teaching sessions to raise awareness of falls risk and implemented a one-page falls risk assessment proforma within the ward admission notes, to be completed by doctors along with an action plan.
Results
D4E ward had good compliance with the proforma. Notes of 48 patients (December–March) revealed over 90% completion in MFRA, cognitive, visual, auditory, mobility, footwear assessments, and ECG. Medication review was completed in 100% of cases. Lying/standing BP recordings improved significantly from 32% to 81%. However, bone health and sarcopenia assessments showed slight improvement. Nearly all reviewed elements had corresponding action plans. Falls data showed a reduction from 15 incidents in November to 7 in February.
Conclusion
The quality of falls risk assessment has significantly improved. We plan to extend the proforma to other wards, assign a physician associate to enhance compliance, and include it in our yearly induction programme to sustain improvement.