The impact of a nursing falls assessment tool on reducing the inpatient falls in a neuro-orthogeriatric ward at the Wits Donald Gordon Medical Centre: an observational study (2014-2018)

Abstract

Background: Inpatient hospital falls are relevant for a number of reasons as they are a common adverse event, a common cause of morbidity among the elderly, a leading cause of injurious death in the elderly, a potential liability for the hospital and may result in increased resource use. To begin to address these problems, there is a need to promote awareness amongst staff members who care for patients at risk of falling in an inpatient hospital setting. There is limited research into effective strategies in reducing inpatient hospital fall rates in both an International and South African context. Objective: To describe the nature and occurrence of inpatient falls in a neuro-orthogeriatric ward at the Wits Donald Gordon Medical Centre. To evaluate whether the clinical implementation of a falls assessment tool reduces the inpatient fall rate and to evaluate if the falls assessment tool correctly identifies patients who have in hospital falls. Methods: A single centre, retrospective study of patients admitted to the neuro-orthogeriatric ward, at the Wits Donald Gordon Medical Centre with review of falls risk assessment data and clinical incident reports of reported falls from prior to implementation of the nursing falls assessment tool (February 2014 to January 2016) to after implementation of the assessment tool (February 2016 to January 2018). The tool was performed by the admitting nurse if patients had any of the risk factors mentioned in the tool. Results: A total of 358 patients were included in the analysis, with 64 patients admitted pre-introduction of the assessment tool and 294 admitted post introduction of the assessment tool. In the post introduction cohort, 91.8% (270 of 294) had falls risk assessments performed at admission, and of these, 84.1% (227 of 270) were complete. There were 15 patients (6.6%) who had a documented fall. The median age of patients who fell was 76 years and 51% were men. Falls occurred mainly in the room of the patient (75.5%), 57.6% occurred after hours and 34% incurred an injury. The study showed a decline in the fall rate pre-introduction of the assessment tool 2.64 per 1000 patient bed days (95%CI 2.02-3.40) versus 1.49 per 1000 patient bed days (95%CI 1.06-2.05) post introduction of the assessment tool. The sensitivity of the assessment tool was a 100% but had very poor specificity of 3.3% (95% CI 0.98-5.63) and a positive predictive value of 6.82% (3.5-10.10%). Conclusion: The study showed a decline in the fall rate post introduction of the nursing falls assessment tool. The tool was shown to be highly sensitive but had very poor specificity and positive predictive value. This small study suggests that raising fall awareness may have an impact on reducing falls