14 Individual Environmental Assessment for Older Inpatients in Medical Wards, Ripas Hospital, Brunei Darussalam

Abstract

Introduction: Falls in hospital cause significant morbidity and mortality for older patients, with 10-25% inpatient falls resulting in lacerations or fractures [Rubenstein, Age Ageing, 2006 Sep; 35Suppl 2:ii37-41]. In addition to patient individual falls risk factors, such as delirium, visual impairment and poor mobility, environmental factors should also be addressed to reduce inpatient falls risk. Methods: An audit of the individual patient's environment or bed space was performed using the Queensland Health Individual Environment Checklist [The Victorian Quality Council Safety and Quality in Health]. Older people aged 65 years and older admitted to the medical wards in Raja Isteri Pengiran Anak Saleha (RIPAS) hospital, Brunei were included. Patients who were bed-bound or immobile were excluded from the audit. Results: There were 30 patients included in this audit. 13 (43%) were male and 17 (57%) female.Median age was 74 years (Range 65 to 83 years). Several issues were identified from this audit: Although bedside tables and lockers were wheeled with a braking system, they were not secure enough to support a patient if they leaned against them. While 28 (93%) had functioning call bells, none of the patients were shown how to operate them. 22 (73%) did not have easy access to call-bells or night-lights. 14 (47%) did not have bedside lockers or tables within easy reach. 17 (57%) did not have mobility aids within reach or received education regarding safety with mobility aid use. Conclusion: This audit highlighted several aspects of the individual patient environment in hospital that should be improved to reduce falls risk. For the medical wards, we recommend ensuring hospital furniture are sturdy enough in case patients lean on them and frequently checking ease of access to call-bells, night lights, walking aids and locker belongings.