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Inpatient Falls

 

The World Health Organisation defines a fall as "an involuntary event resulting to a rest on the ground, floor or other lower level". There are many factors contributing to a fall, including intrinsic causes such as patient’s age, psychological state, medical history, as well as extrinsic causes such as poor lighting, wet floor, floor has obstacles, inappropriate footwear and inappropriate mobility aid.

The undesirable consequences from a fall may lead to physical injuries such as bruising, fractures as well as psychological and social effects. This is known as the ‘post-fall syndrome’, which is the constant fear of a repeated fall, and may cause the victim to disengage in daily activities and thus affecting their quality of life.

In KTPH, we have implemented a comprehensive falls assessment, intervention and education program. Some of these measures include identifying patients as high risk using bright wrist tags and good practices such as customised elimination rounds and incorporating safety features in the design of our environment. Family members and caregivers are educated on falls risk prevention and they are encouraged to follow safe behavioural practices such as putting up cot sides and informing the nurses prior to leaving after visiting. The family members are also encouraged to accompany confused and restless patients during their stay in the hospital.

To improve falls prevention in the community, Annual Falls Awareness Day is held which engages the public in understanding the falls risk and prevention measures as well as resources available in the community.

From January 2016 to June 2018, the mean incidence of inpatient falls per 1000 patient days was 0.81 which is a commendable achievement when benchmarked with national and international healthcare services (2017 National benchmark of 0.88 falls per 1,000 patient days, and 3.53 falls per 1,000 patient days, US, 2013).


Incidence of Inpatient Falls per 1,000 patient days


Reference:

1. Falls among Adult Patients Hospitalized in the United States: Prevalence and Trends, Bouldin ED, National Institutes of Health, J Patient Saf. 2013 March ; 9(1): 13–17. doi:10.1097/PTS.0b013e3182699b64.

2. How do you measure fall rates and fall prevention practices? January 2013. Agency for Healthcare Research and Quality, Rockville, MD. National Database of Nursing Quality Indicator (NDNQI)

3. World Health Organization, Media centre, Falls, Fact sheet, reviewed Jan 2018.

4. Ministry of Health, Singapore, NSHC Self-Assessment Indicators for Public Hospitals and Institutions, 2017