Josephine Sequeira - Royal Prince Alfred Hospital - Partners in Falls-Falls Risk Assessment & Management at the RPA

PARTNERS IN FALLS

Risk Assessment and Management

Royal Prince Alfred Hospital

Josephine Sequeira

C.N.E Geriatric Medicine

Why All The Paperwork?

FALLS INCIDENCE DATA

Falls incidents in 2014

0

2

4

6

8

10

12

14

16

18

FALLS

Feel

Assessment

Look

Listen

Strategies

FEEL

For the work load.

For elderly frail patients.

Baseline Mobility.

Risk of falls, rehabilitation, discharge for all

elderly patient.

ASSESSMENT

Electronic Falls Risk Screening

ASSESSMENT FALLS RISK ASSESSMENT AND MANAGEMENT PLAN

FRAT is mandatory.

FRAMP is mandatory for all patients who have a risk factor.

Compliance is monitored via the use of audits.

Required by National Standards and our local policies.

On admission within four hours FRAT to be completed

followed by FRAMP.

Falls Risk Assessment vs. FRAMP

• Falls risk Assessment is used to highlight risk factors.

• FRAMP is used to put in place Falls intervention strategies

FRAMP What is FRAMP?

Falls

Risk

Assessment

Management

Plan

Completion of FRAT & FRAMP by

month.

Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Completion of FRAT by month %

Completion of FRAMP by month %

Number of Falls by month

Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

0

2

4

6

8

10

12

14

LOOK

BLURRINESS

LISTEN-Background

Listen to the warning signs of falls risk

Listen to the client/family/carer for the needs of the patient,

pain, discomfort in order to assist in keeping calm and to

ensure a familiar environment for the cognitively impaired

patients.

STRATEGIES FOR SAFETY

Medical team and pharmacist provide a daily medication

review.

Occupational therapy review and prepare for discharge.

Physiotherapy provide regular exercises to improve

patients mobility and gait through Active Program.

STRATEGIES FOR SAFETY

Medical investigation to determine the cause of

frailty (e.g., bone weakness, O.P and O.A)

Dietician input -adequate hydration, food intake

Alert devices, falls sensor, pelican belt, helmet.

Signage!

Intentional hourly rounding

What to ask to a patient?

1. PAIN Do you have any pain?

2. Position Do you need assistance to change your position? Are you comfortable?

3. PAN Do you need assistance to go to the bathroom, or would you like a pan?

4. Possession Do you have everything you need close by? Buzzer, water, phone, glasses etc

5. PLUG Is everything plugged in- mattress, phone, IV pumps, PCAs etc.?

Question: Is there anything else I can do for you, I have time?

Finish off with “I will be back in 1 hour to check on you again”.

5‘P’

What Is An Effective Team?

THE PARTNERS IN FALLS ARE: Patient and the family or carers

General Practitioner

Clinician, allied health care workers including physiotherapist, dietician,

occupational therapist, social workers, speech therapists

Medical Team

Pharmacist

Personal carers in the hospital (AIN or wards person)

PATIENT JOURNEY BOARD

Nursing Handover

High falls risk patients are identified at the patient centered

handover and communicated to the next shift

Preparation for discharge – FRAT on day of discharge

Patients who have had a fall whilst an inpatient and who are

discharged home have a Occupational Therapy home visit or

referral to Aged Care Assessment Team (ACAT).

PARTNERS IN FALLS

This is why we need all the paperwork!

Falls Prevention & Management

References Don’t Fall for It- A guide to preventing falls for older people. Commonwealth of Australia, 2008.

http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-injury-dontfall-cnt.htm Fall Injury Prevention and Management in Acute Settings. SSW_PD2009_007 http://www.fallssa.com.au/professional-development/educational-resources/what-is-a-fall-training-video

Falls Are Not For Me! Australian Council for Safety and Quality in Health Care

http://www.safetyandquality.org

Preventing falls and harm from falls in older people-Best Practice Guidelines for Australian Hospitals, Australian Commission for Safety and Quality in Health Care, 2009

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/FallsGuidelines

S:/PATIENTSAFETY & QUALITY UNIT/Patient Safety Officer/Clinical Investigations/2010/964171-20Fall 8W1/INVESTIGATION REPORT ID #96417120_v_final.doc

Acknowledgements

Ms Anthea Temple – CNC Gerontology, CRGH