Authors (including presenting author) :
Fung SY(1), Lee WY(1), Chan HM(2), So PL(3), Chan TH(4), Tang OL(4), Lee LY(4), Wong YY(4), Chan WM(5)
Affiliation :
(1) Department of Orthopaedics & Traumatology, North District Hospital, (2) Central Nursing Department, North District Hospital, (3) Department of Accident and Emergency, North District Hospital, (4) Department of Medicine,North District Hospital, (5) Department of Surgery, North District Hospital
Introduction :
Patient falls can lead to serious consequences, including fractures and increased medical expenses. In 2023, 82 in-patient fall incidents were reported at North District Hospital (NDH). Most fall patients were sound-minded (73%) and ambulatory (51%). Common fall locations were at the scene of toilets (22%) and bedside (67%), primarily due to sudden onset of lower limb weakness (63%) and balance impairment (35%). In order to enhance care quality and patient safety, a Continuous Quality Improvement (CQI) program was piloted in O&T Department (Ward 2D) from January to March 2024’ with enhancement measures included installation of night lights at bedsides, audio-alarm system and hand grab bars were installed in patient toilet and wash basin. Preliminary results indicated a reduction in fall incidents from 3 to 1, a 66.6% decrease compared to the same peroid of previous year. Following its success, the CQI program was further supported by the Quality of Care Program (QOCP) and was implemented to all in-patient wards in August 2024.
Objectives :
The program aims to prevent falls among patients with balance deficits and lower limb weakness, targeting a 30% reduction of fall and its severity among sound-minded ambulatory inpatients (MFAC > 5). It also seek to increase awareness and engagement among staff and patients on fall preventions.
Methodology :
The program focuses on three main strategies:
1.Environmental Enhancements
Infrared sensors were installed in toilets to alert patients beware the risk of fall. Implement motion-sensing night lights at bedside improved visibility and spatial awareness at night. Grab bars were also installed in Orthopaedic ward toilet for extra support to patients.
2.Staff Training(Train-the-trainer)
In-Service Training workshop were conducted with 67 staff attended (1 nurse representative/ward, a total of 17 wards) to reinforce and engage nurses and supporting staff on the importance of fall prevention and the proper use of fall prevention devices. Regular sessions were held with nursing staff to discuss any learning points on the fall incidents and conduct root cause analysis .
3.Patient Education
A training video was created in collaborating with the Physiotherapy Department emphasizing the importance of warm-up exercises to improve stability. A new Fall Prevention video was developed highlighting patients about fall risks and preventive measures. Robot (TEMI) was piloted in 2 wards to broadcast fall prevention information regularly to reinforce patients and their relatives on the importance of fall prevention.
4. Evaluation
A Mid-Term Evaluation was held in December 2024 to assess program’s effectiveness through staff and patient satisfaction survey, as well as monitoring of the fall rates. A final evaluation will be followed in June 2025.
Result & Outcome :
1. Mid-term evaluation
A total of 881 (603 staff, 278 patients) surveys were completed to evaluate the satisfaction levels of patient and staff regarding the acceptability of fall prevention measures.
A considerable number of respondents (530 staff, 256 patients) concurred that the program could enhance awareness of fall prevention. A significant majority (505 staff, 250 patients) believed the measures were effective in preventing falls and the overall satisfaction with the fall prevention measures was notably high (528 staff, 266 patients).
Overall, respondents rated the night light as the most effective measure (253 Staff, 95 Patient). The handgrip over the sink was identified as the most effective measure among the relevant patients (Orthopedic patient=28). Nearly all of the respondents (549 Staff, 252 Patient) agreed the measures were adequate.
2. Fall rate review
By the end of December 2024, total fall incidents decreased from 35 to 18, making a >48% reduction compared to the same period of previous year (August to December 2023) . With positive feedback from both staff and patients, the program will continue until June 2025 reinforcing its commitment to patient safety.
The Fall Prevention Enhancement Program 2024 was largely positively acknowledged by both staff and patients. It successfully increased awareness and improved patient safety, ultimately reducing the number and severity of falls through environmental support, patient education and staff engagement.
