Authors (including presenting author) :
Yip CK(1), Fong MK(1), Chan WMJ(1), Yeung CHJ(1), Chiu HF(1)
Affiliation :
(1)Department of Medicine, Queen Mary Hospital
Introduction :
Falls, especially in elderly patients, are the commonest clinical incident in hospitals, in particular acute medical settings. Disease complexity, congested environment with high bed occupancy, high patient to nurse ratio, polypharmacy as well as aging-related functional and cognitive impairment are the main contributing factors. An acute ward with the highest fall rate, 2.7 and 1.84 per BDO (bed-day-occupied) for 1Q and 2Q2018 (Mean: 2.265), in the Department of Medicine of QMH was selected for implementing a fall reduction program under Total Quality Management (TQM) approach.
Objectives :
This program aimed at (1) reducing the fall rate on a continuous improvement basis through the TQM implementation, (2) increasing the staff alertness at all level in prevention of fall.
Methodology :
New measures were implemented since 3Q2018 through different TQM dimensions. The first dimension was ‘Leadership’. Fall cases were reviewed in the weekly departmental ward manager meeting, improvement measures were implemented accordingly. Furthermore, an ad-hoc improvement visit was held by the HKWC Quality & safety team (Q&S) in September, direct discussion between Top management and frontlines regarding the fall issues were conducted with improvement measures followed. The second dimension was ‘Customer focus’. A newly modified fall risk assessment & care plan form by the Q&S team was implemented in September with prior consultation and training were organized. Ward supervisors would monitor the compliance and effectiveness of measures daily. For ‘Employees’ participation’, fall prevention workshops organized by cluster were allocated to colleagues. Also, after reviewing all the incidents in the 1Q and 2Q, meetings with colleagues were held to identify the root causes and solutions based on the collected data. Besides, fall prevention was added to the ward orientation for all new comers and students for clinical practicum since July. At the same time, to enhance the staff alertness, monthly scoreboard of fall was developed and an eye-catching anti-fall poster was posted at the center of ward. For ‘Process Management’, potty and napkin rounds were rearranged before meal as the peak fall incidence took place at 1100-1200hrs & 1700-1800hrs due to toileting. Lastly for ‘Strategic material management’, apart from ensuring all restraining equipment were adequate and in function, wireless call bells for patients on folding beds and extra alarm mattresses were also introduced with appropriate training provided to staff.
Result & Outcome :
The fall rate of the ward was dropped to 0.69 and 1.06 per BDO (Mean: 0.875) in 3Q and 4Q2018 respectively. On half year basis, it was dropped significantly from 2.265 to 0.875 per BDO which was 61.4% reduction! In addition, a fall preventing culture was cultivated after the program. Therefore, the program would be sustained for continuous service improvement.
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