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PARTNERS IN FALLS
Risk Assessment and Management
Royal Prince Alfred Hospital
Josephine Sequeira
C.N.E Geriatric Medicine
Why All The Paperwork?
FALLS INCIDENCE DATA
Falls incidents in 2014
0
2
4
6
8
10
12
14
16
18
FALLS
Feel
Assessment
Look
Listen
Strategies
FEEL
For the work load.
For elderly frail patients.
Baseline Mobility.
Risk of falls, rehabilitation, discharge for all
elderly patient.
ASSESSMENT
Electronic Falls Risk Screening
ASSESSMENT FALLS RISK ASSESSMENT AND MANAGEMENT PLAN
FRAT is mandatory.
FRAMP is mandatory for all patients who have a risk factor.
Compliance is monitored via the use of audits.
Required by National Standards and our local policies.
On admission within four hours FRAT to be completed
followed by FRAMP.
Falls Risk Assessment vs. FRAMP
• Falls risk Assessment is used to highlight risk factors.
• FRAMP is used to put in place Falls intervention strategies
FRAMP What is FRAMP?
Falls
Risk
Assessment
Management
Plan
Completion of FRAT & FRAMP by
month.
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Completion of FRAT by month %
Completion of FRAMP by month %
Number of Falls by month
Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15
0
2
4
6
8
10
12
14
LOOK
BLURRINESS
LISTEN-Background
Listen to the warning signs of falls risk
Listen to the client/family/carer for the needs of the patient,
pain, discomfort in order to assist in keeping calm and to
ensure a familiar environment for the cognitively impaired
patients.
STRATEGIES FOR SAFETY
Medical team and pharmacist provide a daily medication
review.
Occupational therapy review and prepare for discharge.
Physiotherapy provide regular exercises to improve
patients mobility and gait through Active Program.
STRATEGIES FOR SAFETY
Medical investigation to determine the cause of
frailty (e.g., bone weakness, O.P and O.A)
Dietician input -adequate hydration, food intake
Alert devices, falls sensor, pelican belt, helmet.
Signage!
Intentional hourly rounding
What to ask to a patient?
1. PAIN Do you have any pain?
2. Position Do you need assistance to change your position? Are you comfortable?
3. PAN Do you need assistance to go to the bathroom, or would you like a pan?
4. Possession Do you have everything you need close by? Buzzer, water, phone, glasses etc
5. PLUG Is everything plugged in- mattress, phone, IV pumps, PCAs etc.?
Question: Is there anything else I can do for you, I have time?
Finish off with “I will be back in 1 hour to check on you again”.
5‘P’
What Is An Effective Team?
THE PARTNERS IN FALLS ARE: Patient and the family or carers
General Practitioner
Clinician, allied health care workers including physiotherapist, dietician,
occupational therapist, social workers, speech therapists
Medical Team
Pharmacist
Personal carers in the hospital (AIN or wards person)
PATIENT JOURNEY BOARD
Nursing Handover
High falls risk patients are identified at the patient centered
handover and communicated to the next shift
Preparation for discharge – FRAT on day of discharge
Patients who have had a fall whilst an inpatient and who are
discharged home have a Occupational Therapy home visit or
referral to Aged Care Assessment Team (ACAT).
PARTNERS IN FALLS
This is why we need all the paperwork!
Falls Prevention & Management
References Don’t Fall for It- A guide to preventing falls for older people. Commonwealth of Australia, 2008.
http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-injury-dontfall-cnt.htm Fall Injury Prevention and Management in Acute Settings. SSW_PD2009_007 http://www.fallssa.com.au/professional-development/educational-resources/what-is-a-fall-training-video
Falls Are Not For Me! Australian Council for Safety and Quality in Health Care
http://www.safetyandquality.org
Preventing falls and harm from falls in older people-Best Practice Guidelines for Australian Hospitals, Australian Commission for Safety and Quality in Health Care, 2009
http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/FallsGuidelines
S:/PATIENTSAFETY & QUALITY UNIT/Patient Safety Officer/Clinical Investigations/2010/964171-20Fall 8W1/INVESTIGATION REPORT ID #96417120_v_final.doc
Acknowledgements
Ms Anthea Temple – CNC Gerontology, CRGH