Page 132 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F3.5 Clinical Safety and Quality Services I 14:30 Room 421

Improvement in Fall Assessment and Prevention among Nursing Staff after Refresher Training in Department of
Geriatrics
Po Y, Yuen WM, Cheung KY, Chan S, Mak F, Kng C
Department of Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong

Introduction
The Multidisciplinary Post Fall Review Group of the Department of Geriatrics was set up in March 2015 to review every in-
patient fall incident happening in Geriatric wards prospectively, and make suggestions for secondary fall prevention for the
rest of the individual’s hospital stay and after discharge. The post-fall review of in-patient fall incidents during first and second
quarters 2017 revealed some discrepancies between the Morse Fall Scale rating and the patient’s condition as seen in the
documentation. Accurate assessment is the first and the most important step in prevention of fall and appropriate rating in
fall risk assessment tool could help to provide proper targeted preventive measures to prevent falls. Thus, a refresher training
on fall prevention and management is indicated.
Objectives
To refresh nursing staff’s concept and knowledge of Morse Fall Scale (MFS) to promote precise fall assessment and provide
appropriate preventive measures.
Monday, 7 May 2018 An ad-hoc team for fall prevention enhancement project was set up in June 2017. The records of Post Fall Review Panel
Methodology

Checklist of recent fall cases were reviewed, and a surprise audit on fall prevention documentation was performed in all
geriatric wards and Geriatric Day Hospital (GDH) in July 2017. Three items in Morse Fall Scales were identified as high
variances during fall assessment: (1) ambulatory aid, (2) gait and (3) mental status. Data was analysed for preparation of
the content of training. Three identical scenario-based training workshops called “Smart Tips on Morse Fall Scale” were
launched during early August 2017 for all nursing staff in the Department of Geriatrics, with pre- and post-quiz before and
after the workshop respectively. Post-workshop surprise audit was performed in October 2017 in all geriatric wards and GDH.
All data was analysed to explore the effectiveness of training and performance of staff on fall prevention and assessment
following the workshop.

Results
(1) A total of 45 participants in three workshops. Post-workshops quiz showed better mean scores (Post=3.84, Pre=3.58). (2)
Return rate of staff evaluation after the workshops reached 98%. More than 95% of the nursing staff was satisfied with the
content of the workshops (overall mean score: 5.23/6). (3) Post-compliance audit showed marked improvement in accuracy
and compliance in all three categories of MFS: ambulatory aid (80% ->96.7%); gait (66.7%->100%); and mental status (96.7%-
>100%). (4) The overall compliance in documentation significantly increased from 89.34% to 99% (Z=4.745; p<.001, 2-tailed).

Conclusion
The Multi-disciplinary Post-fall Review Group creates a platform to review practical issues regarding the current fall
prevention and management for further improvement. Scenario-based workshops not only motivate staff’s interest during
the course of training with positive feedback, but also improve the accuracy and appropriateness in fall assessment and
management.

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