Page 126 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F2.1 Staff Engagement and Empowerment 13:15 Room 421

Less Restraint Less Fall
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Kwan SY , Wong CHT , Lai YFJ , Myint J , Chung YKK , Ting KH , Leung SSA , Cheung KH , Ng SWS , Ng HPB , Chan HLI ,
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Chau MWR ,Tang SKR 4
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Central Nursing Division, Rehabilitation and Extended Care Department, Occupational Therapy Department, Physiotheray
Department, Kowloon Hospital, Hong Kong
Introduction
Based on the hospital statistics in 2013 showing a high patient fall rate and high prevalence rate on physical restraint (PR)
for fall prevention, a multi-disciplinary continuous quality improvement (CQI) project on “Less Restraint Less Fall” has been
proposed to minimise restraint in patients who have been restrained for fall prevention. Members including doctor, nurses,
physiotherapists and occupational therapists have held meeting quarterly and half-yearly since November 2014 to review the
collected data for further discussion and planning.
Objectives
(1) To minimise PR in high risk fallers; (2) to reduce fall rate; and (3) to change the frontline staff culture in using physical
restraint to prevent patient falls.
Methodology
Tuesday, 16 May (1) Convenience sampling was used for data collection in the programme. All physical restrained patients in pilot ward(s) for
fall prevention were recruited in the programme during the pilots (first pilot ward trial run from 3 July to 2 October 2015;
and the first and second pilot wards joined the programme from 1 March to 31 August 2016).
(2) Data was collected through direct observation, checking patient notes and nursing records and asking nurses for the
details.
(3) An Advanced Practice Nurse from Central Nursing Division was assigned to monitor the prevalence PR rate and patient
fall rate monthly; clarify the programme’s documentation and solve staffs’ queries on the programme immediately at
least twice per week.
(4) The fall nurse and ward staffs (including doctors, occupational therapists, physiotherapists, and supporting staff) have
been briefed the work flow and document related to the programme in advance.
(5) The progress and results were briefed regularly at meetings of the Multi-disciplinary CQI Project: Less Restraint Less
Fall.
Results
A rehabilitation (REH) ward was chosen to pilot run the PRR Programme for High Risk Fallers from 3 July to 2 October 2015.
The prevalence PR rate for the reason of fall prevention dropped from 93% to 33.3% (average: 51.5%). However, there were
no remarkable changes on the fall rate. We noted incidentally that frontline healthcare members consider as a hazard with
try-off physical restraint for those high risk fallers with dementia/delirium. The programme has also been launched at another
REH ward together since March 16. 30% of the recruited patients had been released successfully before discharge. From on-
site observation, both wards’ prevalence PR rate were noted with a decreasing trend. Both ward’s fall rate had achieved an
improving outcome. The programme could enhance multi-disciplinary staff to gain awareness on fall risk and to implement
less restraint care. The PRR Programme for High Risk Fallers gives evidence on “less restraint less fall” in a multi-disciplinary
approach. Findings from September 2016 to January 2017 showed that, there was also a 27% successful rate to wean off
PR till the patient discharged. 24 falls were reported (14% less than that reported in the period of March to August 2016). The
programme would be handed over to Rehabilitation and Extended Care Department.

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