Authors (including presenting author) :
TO JTS(1), NG PPK(1), YANG MLN(1), CHAN JYH(1), HO JYT(1), LI TKT(1), WONG CHY(1)
Affiliation :
(1)Occupational Therapy Department, Kowloon Hospital
Introduction :
Patient fall incidents remain the first priority in the risk registry of Occupational Therapy Department in Kowloon Hospital in the pass years. In order to improve the patient safety and quality of services, some interventions to prevent patient fall incidents while receiving treatment are required. A fall prevention audit is introduced to review the current practice of Occupational Therapy Department in Kowloon Hospital in patient handling, environmental setup, staff training and communication. Through the process, some gaps concerning fall prevention were identified and sustainable interventions were implemented to enhance safe care and service provided by all levels of our colleague.
Objectives :
Current practice of different specialty unit of Occupational Therapy Department in Kowloon Hospital was reviewed in the Departmental, Patient, Staff and Environmental aspects according to the “The Fall Prevention Audit Inspection Checklist”. In the Departmental aspect, Intervention to improve the accessibilities of the guidelines by all level of staff. In Patient aspect, fall prevention poster was renewed to provide more eye-catching remind patients in importance of fall prevention. In Staff aspect, a standardized Fall Prevention Training package for all level of staff which covered the content of General Fall information and patient’s condition, proper use of wheelchair, wheelchair transfer, plinth activities, standing frame activities and use of hoist was developed and rolled out. Finally, Fall Prevention Audit to difference specialty unit using The Fall Prevention Audit Inspection Checklist was implemented.
Methodology :
The Fall Prevention Audit Inspection Checklist (version updated in Feb, 2015) was developed by Quality and Safety Sub group of OTCOC of Hospital Authority is chosen to be the tool of measurement. Total 20 questions on the checklist which covered four areas of inspection: Departmental, Patient, Staff and Environmental providing a comprehensive measure of different aspect of fall prevention practice. Each question has rating scale of “Yes”, “No” and “NA”.
The seven specialty units of Occupational Therapy Department which covered all the adult rehabilitation service in Kowloon Hospital were involved. Cross-team preliminary checking and rating was conducted and the interpretation part of the checklist was enriched to facilitate better understanding of the auditing items and standard. Briefing sessions were conduction to all staff of every specialty unit of OT department to ensure all staff understood the purpose and the content of the audit exercise. Cross team Fall prevention Audit were rolled out finally.
Compliance rate of different items on the checklist was analyzed and key performance index of the Audit should be 80% compliance rate of the questions.
Result & Outcome :
Seven specialty units with 10 locations including Physical rehabilitation units, Psychiatric rehabilitation, Respiratory rehabilitation unit in KHMB, Psychiatric rehabilitation unit and Psychogeriatric rehabilitation unit in West Wing were checked using the fall prevention audit inspection checklist. The “Yes” response implied the compliancy of the checking item and “No” response indicated discrepancy from the requirement of the area and further improvement implied. The compliancy rate of individual specialty unit was calculated by dividing total number of “Yes” response by the total number of “Yes” and “No” response of the 20 questions time 100 percent.
The result indicated six locations achieved 100 percent of compliance in the all four parts of the checklist and four locations complied 93 to 95 percent. Good practices of individual specialty unit were recorded and will be shared session with colleagues in debriefing and report back sessions. Average severity of patient fall incident captured from the data of AIRS in the half year after the audit was only 1.5 which is less than the data of last five years i.e. 2(2013-14), 2(2014-15), 2.3(2015-16, 1.7(2016-17) and 2.3(2017-18).
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