Standard 5: Comprehensive Care

Preventing falls and harm from falls

Action 5.24

The health service organisation providing services to patients at risk of falls has systems that are consistent with best-practice guidelines for:

a. Falls prevention

b. Minimising harm from falls

c. Post-fall management

Intent

Clinical practice for preventing and managing falls is evidence based, and patient risks and harm are minimised.

Reflective questions

How does the health service organisation ensure that falls prevention, harm minimisation and post-fall management plans are consistent with best-practice guidelines?

Key task

Identify all areas in the organisation that present falls risks and develop a risk management approach to implementing evidence-based improvement strategies.

Strategies for improvement

Hospitals

Falls remain a major safety and quality risk in health service organisations. Falls prevention and harm minimisation plans based on best practice and evidence can improve patient outcomes.

Best-practice guidelines and guides for preventing falls and harm from falls in older people are available on the Commission’s website.1-3

These resources were developed for hospital, community and aged care home settings. The resources comprise detailed guidelines, shorter guidebooks and fact sheets, and include strategies for falls prevention, managing falls risks and responding to falls.

Many organisations and expert bodies have developed falls prevention resources that can be used by health service organisations.

Delirium should be considered a risk factor for falls.4 Refer to Action 5.29 and the Delirium Clinical Care Standard for strategies to manage risks of harm related to delirium.

Day Procedure Services

For many day procedure services, falls may not be a major area of patient harm. However, falls do occur in these settings, and prevention strategies will need to be in place.

Falls prevention and harm minimisation plans based on best practice and available evidence can improve patient outcomes.

Screening processes (see Action 5.10) should identify at-risk patients. Monitoring of falls reported through the incidents management system (see Action 1.11) will allow day procedure services to understand the risks and causal factors leading to falls, and allow prevention and harm minimisation strategies to be implemented.

Where the harm from falls is significant, post-falls management may occur at another health service organisation.

Delirium should be considered a risk factor for falls.4 Refer to Action 5.29 and the Delirium Clinical Care Standard for strategies to manage risks of harm related to delirium.

Refer to Action 1.29 for strategies to ensure that the built environment supports safe and high-quality care, and reflects the patient’s clinical needs.

Examples of evidence

Select only examples currently in use:

  • Policy documents that
    • are consistent with best-practice guidelines
    • include processes for post-fall management
  • Data on falls from the previous 12 months
  • Tools and resources to prevent falls and minimise harm from falls
  • Audit results of healthcare records to determine whether patients at risk of falls are assessed and managed in line with best-practice guidelines
  • Templates for falls prevention, harm minimisation and post-fall management plans
  • Observation of the use of falls prevention plans
  • Feedback from patients to evaluate falls prevention plans against care provided.
MPS & Small Hospitals

Falls remain a major safety and quality risk in health service organisations. Falls prevention and harm minimisation plans based on best practice and evidence can improve patient outcomes.

Best-practice guidelines and guides for preventing falls and harm from falls in older people are available on the Commission’s website.1-3

These resources were developed for hospital, community and aged care home settings. The resources comprise detailed guidelines, shorter guidebooks and fact sheets, and include strategies for falls prevention, managing falls risks and responding to falls.

Many organisations and expert bodies have developed falls prevention resources that can be used by health service organisations.

Delirium should be considered a risk factor for falls.4 Refer to Action 5.29 and the Delirium Clinical Care Standard for strategies to manage risks of harm related to delirium.

Action 5.25

The health service organisation providing services to patients at risk of falls ensures that equipment, devices and tools are available to promote safe mobility and manage the risks of falls

Intent

Patients are provided with equipment and devices to promote safe mobility and reduce harm from falls.

Reflective question

What equipment and devices are available for patients to prevent harm from falls or to manage patients who are at risk of falling?

Key tasks

  • Identify and facilitate access to the equipment and devices required for the organisation’s patient population.

  • Develop a log to register equipment and devices used in falls prevention and management, and record their maintenance.

Strategies for improvement

Hospitals

Adjust the environment in line with a patient’s risk profile and make equipment available for the patient to mitigate the risk of falling. This may include:

  • Adjusting chair and bed heights
  • Using lighting that is even and activated by sensors, particularly over stairs and at night
  • Providing slip-resistant surfaces
  • Providing well-maintained walking aids and wheelchairs
  • Reducing clutter and trip hazards around the patient
  • Cleaning up spills and urine promptly
  • Providing stable furniture for handholds
  • Ensuring effective brakes on beds, wheelchairs and commodes
  • Reducing the use of physical restraints
  • Placing call bells within reach.

Special equipment can include commodes, body protective equipment and appropriate footwear.

Recording and monitoring equipment and devices may include:

  • Evaluating previous equipment and device requirements and effectiveness
  • Determining the type and number of support devices the organisation may require, and options for access to the equipment
  • Scheduling routine maintenance and coordinating repairs to maximise the availability of equipment
  • Reviewing falls incident reports to evaluate the role that access to equipment played in the incident.
Day Procedure Services

Where the risk of falls or harm from falls is low, the need for equipment and devices will be limited.

Adjust the environment in line with the patient risk profile and make equipment available for the patient to reduce the risk of falling. This may include:

  • Adjusting chair and bed heights
  • Using lighting that is even and activated by sensors, particularly over stairs and at night
  • Providing slip-resistant surfaces
  • Providing well-maintained walking aids and wheelchairs
  • Reducing clutter and trip hazards around the patient
  • Cleaning up spills and urine promptly
  • Providing stable furniture for handholds
  • Ensuring effective brakes on beds, wheelchairs and commodes
  • Reducing the use of physical restraints
  • Placing call bells within reach.

Best-practice guidelines and guides for preventing falls and harm from falls in older people are available on the Commission's website.1-3

Refer to Action 1.29 for strategies to ensure that the built environment supports safe and high-quality care, and reflects the patient’s clinical needs.

Examples of evidence

Select only examples currently in use:

  • Inventories of equipment and audit of clinical use
  • Maintenance logs of equipment and devices
  • Policy documents about equipment procurement and provision
  • Documented systems for reviewing and procuring equipment and devices
  • Committee and meeting records that note responsibilities for evaluating the effectiveness of products, equipment and devices.
MPS & Small Hospitals

Identify, and facilitate access to, the equipment and devices required for the organisation’s patient population. Adjust the environment in line with a patient’s risk profile and make equipment available for the patient to reduce the risk of falling. This may include:

  • Adjusting chair and bed heights
  • Using lighting that is even and activated by sensors, especially over stairs and at night
  • Providing slip-resistant surfaces
  • Providing well-maintained walking aids and wheelchairs
  • Reducing clutter and trip hazards around the patient
  • Cleaning up spills and urine promptly
  • Providing stable furniture for handholds
  • Ensuring effective brakes on beds, wheelchairs and commodes
  • Reducing the use of physical restraints
  • Placing call bells within reach.

Special equipment can include commodes, body protective equipment and appropriate footwear.

Develop a log to register equipment and devices used in falls prevention and management, and record their maintenance. This may include:

  • Evaluating previous equipment and device requirements and effectiveness
  • Determining the type and number of support devices the organisation may require, and options for access to the equipment
  • Scheduling routine maintenance and coordinating repairs to maximise the availability of equipment
  • Reviewing falls incident reports to evaluate the role that access to equipment played in the incident.

Action 5.26

Clinicians providing care to patients at risk of falls provide patients, carers and families with information about reducing falls risks and falls prevention strategies

Intent

Patients, carers and families are provided with information about falls risks and preventing falls.

Reflective question

What information and support are provided to patients and carers about falls risk and prevention?

Key tasks

  • Provide information to, and have discussions with, patients, carers and families about falls risks.

  • Seek feedback on information provided to patients and carers, and amend it to improve the information.

  • Ensure that the discharge planning protocol prompts the workforce to consider referral to appropriate services.

Strategies for improvement

Hospitals

Provide patient information

Involving patients, carers and families in the development of falls prevention and harm minimisation strategies may reduce the frequency and severity of falls. Providing information to, and discussing information with, patients, carers and families will help them understand and take part in the prevention and management strategies.

Fact sheets for patients are available that describe different aspects relating to falls.

Seek feedback from patients, carers, families and the workforce about the information provided to patients to inform quality improvement.

Ensure access to referral services

Create a log of services available that accept referred patients after discharge.

Set the criteria for referral, and include these in policies, procedures and protocols.

Detail prevention strategies, falls risks and patient history in discharge information to enable continuity of care between health services.

Day Procedure Services

Provide patient information

For patients who are at risk of falling or sustaining harm from a fall during care at a day procedure service, or immediately after an episode of care, provide patients or their carers with practical information about the factors that contribute to falls and how to prevent falls.

Fact sheets for patients are available that describe a range of aspects relating to falls.

Examples of evidence

Select only examples currently in use:

  • Consumer and carer information packages or resources about falls risks
  • Audit results of healthcare records to determine whether information about falls risks and prevention strategies was provided to the patient
  • Results of patient and carer experience surveys, and organisational responses, in relation to information provided about falls risks and falls prevention strategies.
MPS & Small Hospitals

Provide patient information

Involving patients, carers and families in discussions about falls risks and the development of falls prevention and harm minimisation strategies may reduce the frequency and severity of falls. Providing information to, and discussing information with, patients, carers and families will help them understand and take part in the prevention and management strategies.

Fact sheets for patients are available that describe different aspects relating to falls.

Seek feedback from patients, carers, families and the workforce about the information provided to patients to inform quality improvement.

Ensure access to referral services

Create a log of services available that accept referred patients after discharge.

Set the criteria for referral, and include these in policies, protocols and procedures.

Detail prevention strategies, falls risks and patient history in discharge information to enable continuity of care between health services.

Last updated 5th July, 2018 at 08:22pm
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References

Australian Commission on Safety and Quality in Health Care. Preventing falls and harm from falls in older people: best practice guidelines for Australian residential aged care facilities. Sydney: ACSQHC; 2009.

Australian Commission on Safety and Quality in Health Care. Preventing falls and harm from falls in older people: best practice guidelines for Australian community care. Sydney: ACSQHC; 2009.

Australian Commission on Safety and Quality in Health Care. Preventing falls and harm from falls in older people: best practice guidelines for Australian hospitals. Sydney: ACSQHC; 2009.

Hshieh TT, Yue J, Oh E, Puelle M, Dowal S, Travison T, et al. Effectiveness of multi-component non-pharmacologic delirium interventions: a meta-analysis. JAMA Intern Med 2015;175(4):512–20.