Preventing falls and stump injuries in lower limb amputees during inpatient rehabilitation: completion of the audit cycle.

OBJECTIVES: To study the factors contributing to falls among recent lower limb amputees, and to reduce the number of falls during inpatient rehabilitation and resulting injuries.
DESIGN: Retrospective, followed by prospective, cohort study, then a follow-up study conducted after interventions.
SETTING: Twenty-bedded inpatient rehabilitation unit for amputees.
SUBJECTS: Lower limb amputees.
INTERVENTIONS: Patient education, environmental modifications and application of a bivalve plaster of Paris stump protector to patients who were aged 70 or over, or cognitively impaired. MAIN OUTCOME MEASURES: Numbers of falls and other accidents, and resulting injuries.
RESULTS: In phase 1 of the study, a retrospective audit of incident forms that had been completed on lower limb amputees who had an accident during their inpatient rehabilitation, between 1 April 1996 and 31 Ocotber 1998, was carried out. This showed that approximately a third of admissions (32%) were complicated by an accident. Most accidents were falls. In phase 2, a prospective study of 113 patients admitted to the unit was undertaken. Patients who fell were significantly older than those who did not. In phase 3, 62 consecutive patients were studied. There were 37 accidents in total, of which 35 were falls. Compared with the phase 2 study, there was no reduction in the proportion of patients who had a fall or other accident in phase 3, but significantly fewer falls resulted in any injury (p = 0.05).
CONCLUSIONS: Although the interventions employed did not reduce the proportion of patients who had falls or other accidents, significantly fewer falls resulted in injuries.