Article type
Abstract
Background：WHO related survey show that the annual incidence of falls in the elderly over 80 years is 40%~50%, and the incidence of falls in the hospitalized elderly over 60 years is about 30%.In terms of falling places: 30% in community and 60% in hospital. In 2022, the proportion of adverse events in our hospital was 21.18%, and the current situation is grim.
Objectives：The project aimed to implement the best evidence-based recommendations for falls assessment and prevention in older hospital inpatients, and reduce the incidence of falls in elderly inpatients.
Methods：The quality improvement project used the JBI ( Joanna Briggs Institute) evidence implementation framework. The JBI evidence implementation approach is grounded in the audit, feedback and re-audit process along with a structured process for the identification and management of barriers to compliance with recommended clinical practices. Fifteen nurses, who received support from external facilitators.
Results：Nine experts were invited to conduct analysis of the clinical applicability of the evidence from the feasibility, suitability, clinical significance and validity of FAME. The final evidence-based care protocol for multifactorial management of falls in elderly inpatients includes inpatient environmental safety, health education system, medicines, drug management, paraphernalia guidance, exercise training, and multifactorial management of diseases . Baseline audit of 38 elderly inpatients notes showed poor compliance (range 0%–84.21%) to recommended practices relating to screening, assessment, prevention and management of falls. Barriers analysis revealed nurse-related (eg. Lack of appropriate and comprehensive exercise education resources relevant to fall prevention) , patients’ level factors (e.g. Elderly patients have insufficient willingness to self-participate ) and organisational level factors (e.g. Insufficient human resources). Follow-up audit of 31 elderly inpatients notes demonstrated significant improvements in compliance with best practice recommendations for all falls aspects .
Conclusions：The project has provided multifactorial fall risk assessment for elderly inpatients with high risk of falls, improved proactive prevention capacity among elderly inpatients, and provided personalized diversified health education guidance for high risk of falls. These changes will help to improve the prognosis of elderly hospitalized patients , provide certain reference value for fall prevention and also highlights the need to refocus on initiative in exercise participation.
Objectives：The project aimed to implement the best evidence-based recommendations for falls assessment and prevention in older hospital inpatients, and reduce the incidence of falls in elderly inpatients.
Methods：The quality improvement project used the JBI ( Joanna Briggs Institute) evidence implementation framework. The JBI evidence implementation approach is grounded in the audit, feedback and re-audit process along with a structured process for the identification and management of barriers to compliance with recommended clinical practices. Fifteen nurses, who received support from external facilitators.
Results：Nine experts were invited to conduct analysis of the clinical applicability of the evidence from the feasibility, suitability, clinical significance and validity of FAME. The final evidence-based care protocol for multifactorial management of falls in elderly inpatients includes inpatient environmental safety, health education system, medicines, drug management, paraphernalia guidance, exercise training, and multifactorial management of diseases . Baseline audit of 38 elderly inpatients notes showed poor compliance (range 0%–84.21%) to recommended practices relating to screening, assessment, prevention and management of falls. Barriers analysis revealed nurse-related (eg. Lack of appropriate and comprehensive exercise education resources relevant to fall prevention) , patients’ level factors (e.g. Elderly patients have insufficient willingness to self-participate ) and organisational level factors (e.g. Insufficient human resources). Follow-up audit of 31 elderly inpatients notes demonstrated significant improvements in compliance with best practice recommendations for all falls aspects .
Conclusions：The project has provided multifactorial fall risk assessment for elderly inpatients with high risk of falls, improved proactive prevention capacity among elderly inpatients, and provided personalized diversified health education guidance for high risk of falls. These changes will help to improve the prognosis of elderly hospitalized patients , provide certain reference value for fall prevention and also highlights the need to refocus on initiative in exercise participation.