Authors (including presenting author) :
Kam WKI (2), Wong SM (2), Cheng PSP (1), Leung CY(1), Tsang PL(1), Luk KH(1)
Affiliation :
(1)Department of Psychiatry, Shatin Hospital, (2)Department of Psychiatry, NTEC/Prince of Wales Hospital/ Shatin Hospital
Introduction :
Falls are a common and serious problem in healthcare, particularly in psychiatric in-patient settings where patients may be at increased risk of falls due to factors such as medication side effects, cognitive impairment, or mental state and behavioral issues. Incidence of falls in psychiatric inpatient units can be up to 3-4 times higher compared to other hospital wards (Seeherunwong et al, 2022). Falls in inpatient settings often result in serious injuries, such as fractures, head trauma, and soft tissue injuries. These injuries can lead to prolonged hospitalization, delayed recovery, and a higher risk of morbidity and mortality. Therefore, fall prevention is an important aspect of healthcare, particularly in psychiatric in-patient settings.
Objectives :
1) To reinforce fall preventive knowledge for patients, specifically related to mental health problems & psychiatric medication. 2) To implement fall prevention strategy related to risk of orthostatic hypotension due to psychiatric medication. 3) To reduce the risk of injury by use of fall preventive and injury reduction devices. 4) To enhance patients’ mobility by using mobility aids & regular exercise rounds in ward.
Methodology :
A five-month study was conducted in five psychiatric wards at Shatin Hospital starting July 2024,involving all in-patient psychiatric patients and staff.1.Staff training on risks of fall associated with orthostatic hypotension caused by psychiatric drugs 2.Orthostatic blood pressure measurements for high-risk patients with reference to Pharmacy “Common drugs associated with increased fall risk” and measurement by “5-3-1” CDC STEADI tools, and standardized documentation for communication with multi-disciplines. Audit on documentation & fall preventive measures for identified at risk cases. 3.Apply new devices for patient with fall risk e.g Airbag vest on fall prevention, injury reduction & mobility enhancement, with regular sessions on assisting patients to perform mobility exercise. 4. Fall prevention educational video specifically targeted for psychiatric inpatients’ risks of fall. 5. Staff survey to evaluate knowledge and skills in fall prevention to psychiatric patients.
Result & Outcome :
Patient fall rate decreased by 66.7% in 2024, average fall rate per month decreased from 0.39 to 0.13 with the start of the program. For Orthostatic blood pressure measurement, 30.4% of patients who were new to antipsychotics & 14.4% of patients with drug increment of the common drugs were screened out to have orthostatic hypotension. Fall education and case review by medical officer would be implemented. Audit shown 100% compliance in standardized documentation and fall preventive measures taken. Daily mobility exercise sessions were conducted in wards using mobility aids and fall preventive devices. The results of staff survey showed improved confidence in fall assessment and interventions specific for psychiatric patients. The SAFE program helped early identification of fall risks cases related to psychiatric medications, safeguarding patients from risk of fall by using devices for fall prevention. Further related fall prevention care package was suggested.
