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Falls Prevention Assessment in Occupational Therapy

Western Sydney Local Health District
Project Added:
9 October 2015
Last updated:
23 October 2015

Falls Prevention Assessment in Occupational Therapy

Summary

This project developed guidelines and resources to improve occupational therapist (OT) staff compliance with departmental protocols in place at Blacktown Mount Druitt Hospital. 

Aim

To provide 100% of patients who are seen by an OT at Blacktown Mount Druitt Hospital, with a documented falls history and a falls mitigation plan if required, within eight months.

Benefits 

  • Provides all patients at Blacktown Mount Druitt Hospital with a screening for previous falls, assessment of risk factors and falls mitigation plan.
  • Increases OT awareness of the impact of falls and skills to implement interventions as required.

Project status

Dates

Started:  20 August 2014.

Status

Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.

Background

OTs play a critical role in falls prevention both in hospital and within the home environment.

In early 2014, it was identified through routine audits that the OT team at Blacktown Mount Druitt Hospital did not consistently ask patients about recent falls. If they did, they did not consistently provide a falls mitigation plan. The initial audit results are shown below (Figure 1).

OT audit results 2014 - history apptox 70-80%, plan approx 60%
Figure 1.

A clinical practice methodology was used to further explore the extent of the problem.  A project team comprising five staff members and one consumer representative was assembled, with monthly meetings held at Blacktown Hospital. The team completed brainstorming, multi-voting and affinity diagrams to determine the key causes of the issue, which included the following points.

  • Staff were unsure of current evidence for falls mitigation.
  • There was an outdated departmental policy.
  • Staff were unsure of external agencies for referral, such as falls prevention programs.
  • Staff were unsure of how to take a detailed falls history.
  • Staff were unclear of the OTs role in falls education.
  • Staff were afraid of delaying discharge.

A voting system was used to determine the most appropriate solutions to these challenges. A table was developed and tasks were allocated to team members (Figure 2).

Impact and effort matrix 
Figure 2.

Implementation 

  • Conducted a literature review of current evidence for falls prevention and OT interventions.
  • Identified what education and interventions were provided by the physiotherapy department in a recent falls project.
  • Reviewed the falls assessment and management plans of OT departments in two other hospitals.
  • Developed new departmental guidelines, titled ‘Occupational Therapy Management of Patients with an Identified Falls Risk’.
  • Developed a handout for OT staff with referral details of external agencies, including falls programs and falls clinics.
  • Developed a falls assessment and intervention card for therapists to carry on their identification badge as a reference.
  • Developed an electronic falls resource, accessible by all staff on the OT shared drive.
  • Conducted a staff education session in December 2014 to review the project, inform the department of the interventions in place and learn from an equipment representative.

Implementation sites

  • Blacktown and Mount Druitt Hospitals, Western Sydney Local Health District

Partnership

  • Clinical Leadership Program 

Results

  • Routine documentation audits were conducted between January and March 2015 (Figure 3). Results from these audits found:
    • a 17% increase in OTs taking a detailed falls history, reaching the aim of 100% compliance in this category
    • a 10% increase in OTs implementing a falls risk mitigation plan (where applicable) with an average of 69% compliance in 2015.
  • A feedback form was provided to acute department OTs to determine the effectiveness of the falls education session. A total of 4/10 feedback forms were received. General feedback was positive, however more education was requested.

OT audit results 2015 showing history 100% and rise in plan from 60% to over 80%
Figure 3.

Further reading

  • Pighills A, Torgerson D, Sheldon T et al. Environmental Assessment and Modification to Prevent Falls in Older People. The American Journal Society 2011; 59:26-33.
  • Australian Commission on Safety and Quality in Health Care (ACSQHC). Preventing Falls and Harm from Falls in Older People - Best Practice Guidelines for Australian Community Care. Commonwealth of Australia 2009.
  • Cameron ID, Gillespie LD, Robertson MC et al. Interventions for preventing falls in older people in care facilities and hospitals (Review). The Cochrane Library 2012; 12.
  • Gillespie WJ, Gillespie LD, Parker MJ. Hip protectors for preventing hip fractures in older people (Review). The Cochrane Library 2011; 11.
  • Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community (Review). The Cochrane Library 2012; 9.

Contact

Megan Smyth
Senior Occupational Therapist
Blacktown Mount Druitt Hospitals
Western Sydney Local Health District
Phone: 02 9881 8457
Megan.Smyth@health.nsw.gov.au

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