Background: Falls are the most reported patient safety incident for patients >65 years in acute hospital settings worldwide. While multifactorial fall interventions reduce the number of falls in subacute and rehabilitation settings, fall interventions in acute hospital settings are unknown.
Aim: To evaluate the effectiveness of multifactorial fall interventions on the number of falls using codesigned education targeting staff and the patient and review the environment in acute hospital settings in NSW, Australia for patients over 65 years of age.
Method: A pre-post-test design with a non-equivalent group was conducted. All acute hospital inpatient falls occurring both pre- and post-intervention within one health district were included in this study. The use of Quality Improvement methodology identified gaps in risk screening and assessment, education and information, communication of risk, and standardised fall prevention equipment. Codesigned interventions to address these gaps were undertaken.
Results: The number of falls (p = 0.038) and injurious falls (p < 0.001) significantly decreased in the post-intervention group. There was a significant improvement in fall assessments (p < 0.001), delirium risk screening (p < 0.001), the provision of fall information (p < 0.001) and fall risk discussed at shift handover (p < 0.001) in the post-intervention group. Following the intervention, staff were significantly more likely to undertake fall education modules (p < 0.001) and develop a fall management plan (p < 0.001).
Conclusion: Falls continue to have a significant economic impact on the acute hospital setting. Our findings highlight multifactorial fall interventions that included staff and patients in the development phases reduced the number of falls. Multifactorial fall interventions targeting staff, patients and the environment may influence a reduction in the number of falls and the severity of falls in the acute hospital setting.
Impact statement: Multifactorial fall interventions reduce injurious falls, minor injuries, and falls resulting in serious injury and death.
Keywords: Acute hospital setting; education; fall assessment; fall risk; falls; multifactorial Interventions.
Falls in acute hospital settings for people over the age of 65 years are a common patient safety incident that causes injury and death. The impact of falls on people over the age of 65 years in the acute hospital setting is significant, particularly for those with cognitive impairment. Interventions that involve multiple strategies reduce the number of falls in non-hospital settings; however, it is largely unknown if multifactorial fall interventions are effective in acute hospitals. We evaluated a multifactorial fall intervention that included patients and bedside nurses in the development phase of falls education and information resources, provided staff with the education and tools to undertake falls prevention projects and standardised fall equipment. The effectiveness of the multifactorial intervention was measured using several data sources. We found the number of falls and the number of falls resulting in injury reduced following the implementation of the multifactorial fall intervention. Following the intervention, staff were more likely to undertake fall education modules, develop fall management plans, and document the patients’ fall risk during shift handover.