Frances Healey1, Derek Lowe2, Adam Darowski3, Julie Windsor4, Jonathan Treml5, Lisa Byrne6, Janet Husk2, Jill Phipps7. 1. NHS England, London, UK. 2. Royal College of Physicians, London, UK. 3. Oxford Radcliffe Hospitals, Oxford, UK. 4. Portsmouth Hospitals NHS Trust, Portsmouth, UK. 5. University Hospitals Birmingham, Birmingham, UK. 6. Great Ormond Street Hospital, London, UK. 7. Southern Health, Southampton, UK.
Abstract
BACKGROUND: inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20-30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle. METHODS: : data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys. RESULTS: : in FallSafe units, delivery of seven care bundle components significantly improved; most improvements were sustained after active project support was withdrawn. Twelve-month moving average of reported fall rates showed a consistent downward trend in FallSafe units but not controls. Significant reductions in reported fall rate were found in FallSafe units (adjusted rate ratio (ARR) 0.75, 95% confidence interval (CI) 0.68-0.84 P < 0.001) in the 12 months following full implementation but not in control units (ARR 0.91, 95% CI 0.81-1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71-1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72-1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%. CONCLUSION: : introducing evidence-based care bundles of multifactorial assessment and intervention using a quality improvement approach resulted in improved delivery of multifactorial assessment and intervention and significant reductions in fall rates, but not in injurious fall rates.
BACKGROUND: inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20-30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle. METHODS: : data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys. RESULTS: : in FallSafe units, delivery of seven care bundle components significantly improved; most improvements were sustained after active project support was withdrawn. Twelve-month moving average of reported fall rates showed a consistent downward trend in FallSafe units but not controls. Significant reductions in reported fall rate were found in FallSafe units (adjusted rate ratio (ARR) 0.75, 95% confidence interval (CI) 0.68-0.84 P < 0.001) in the 12 months following full implementation but not in control units (ARR 0.91, 95% CI 0.81-1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71-1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72-1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%. CONCLUSION: : introducing evidence-based care bundles of multifactorial assessment and intervention using a quality improvement approach resulted in improved delivery of multifactorial assessment and intervention and significant reductions in fall rates, but not in injurious fall rates.
Authors: Meg E Morris; Kate Webster; Cathy Jones; Anne-Marie Hill; Terry Haines; Steven McPhail; Debra Kiegaldie; Susan Slade; Dana Jazayeri; Hazel Heng; Ronald Shorr; Leeanne Carey; Anna Barker; Ian Cameron Journal: Age Ageing Date: 2022-05-01 Impact factor: 12.782
Authors: Anna L Barker; Renata T Morello; Rory Wolfe; Caroline A Brand; Terry P Haines; Keith D Hill; Sandra G Brauer; Mari Botti; Robert G Cumming; Patricia M Livingston; Catherine Sherrington; Silva Zavarsek; Richard I Lindley; Jeannette Kamar Journal: BMJ Date: 2016-01-26