31THE INTRODUCTION OF A POST-FALL MEDICAL REVIEW: PROFORMA IN A LARGE ACADEMIC HOSPITAL

Abstract

Topic: Falls account for approximately 30% (Oliver, Healey & Haines Clin Geriatr Med (2010) 26:645) of all adverse incidents in the hospital. New NICE guidelines (Falls in Older People NICE 2015) recommend that all patients who fall in hospital should have a medical review. A medical review post-fall provides an important opportunity to identify and manage injury appropriately and prevent further falls. Intervention: Our hospital introduced a Post-Fall Medical Review: Proforma to be completed by medical staff who reviewed a patient in the immediate post-fall period. A convenience sample of 30 people who fell in hospital before and after (total n = 60) the introduction of the Proforma was selected from the adverse incident reporting system. The data collection tool comprised the following themes: history and clinical examination, injury management, and preventing further falls. Improvement: History: There was an improvement in documenting the 'mechanism of fall' (30%) and in questioning patients on hip trauma (60%). Clinical Examination: There as a 65% increase in medical staff considering sepsis, delirium or dementia in the immediate post-fall period. Preventing Further Falls: There was an increase in the number of high risk medications identified (40%) and in the number of medications rationalised (45%). Discussion: A particular challenge in the introduction of the Proforma was in educating all medical staff. The high turnover of staff throughout rotations made consistency a challenge so support from ward nursing staff was vital. Interns were supportive of its introduction as it simplified assessment, particularly during a busy call. However, consultants need to champion its use to ensure that risk factors for falling, such as medication rationalisation, are acted upon. Focus should now be on ensuring sustainability through a hospital-wide education programme and regular audits to ensure compliance.