Introduction
Falls are serious cause of morbidity and costs, especially in Cancer Palliative Care. Most patients with these incurable diseases were aged, terminally-ill and highly stressful. Patients with bone metastasis or brain metastasis were extremely high risk. Cancer patients could suffer from more immense consequences of physical injuries, fractures, post-fall syndrome and functional decline. It was also followed by prolonged hospital stays, follow-up investigations and treatments; consequently, it increased the costs and risks significantly in health care system. To take comprehensive preventive measures, 5S-Strategy was launched.
Objectives
To reduce fall rate To minimize prolong hospital stay due to fall To enhance staff engagement To foster safety culture
Methodology
Systems Universal screening was performed for all patients upon admissions. The individual needs of screened patients would be addressed, such as assisted toileting round, morning warm water round, providing non-skid slippers, alarm pad and yellow vest, keeping bed at low level, and providing anti-slippery spray. All these rounds aimed at improving the observation level and preventing high risk activities for example toileting and filling warm water. Strategy Post-fall incident investigation of each fall is a necessary component and must indicate how a client was assessed and the specific strategies implemented for that patient to prevent further falls. The results for every new operation would be documented and announced. Shared Values High-risk patients and their relatives would be engaged through face-to-face discussions or phone call. Education would be given and consensus would be gained to achieve mutual understanding. When patients, relatives and clinicians had the same shared values and goals, patients would comply with instructions from the ward. Staff Multidisciplinary approaches, including physicians, nurses, physiotherapists, occupational therapists, were involved in the fall program. Repeated assessments would be conducted as conditions of cancer patients would deteriorate suddenly. Multidisciplinary approaches with repeated assessments can provide a quick response to change of conditions and timely prevention can be taken in advance. Skills Supporting staff was trained as the eyes of clinicians. Two workshops were provided by nurses annually. In each shift, supporting staff would be informed of the patients with high risks. As supporting staff had a high intensity of interaction with patients, they were able to enhance the observation level and provide assistance.
Results & Outcome
The fall rate decreased from 10.04 cases per 1000 episodes in 2012/13 to 4.89 cases per 1000 episodes in 2017/18. Causes of falls are multiple and hard to prevent all of them. The preventive measures should be from different angles and implemented by different people.
Co-location with:
