Falls prevention in an older adult mental health ward through a quality improvement initiative

Abstract

Falls in the inpatient units are the most frequently reported patient safety incidents and their consequences can be devastating. Risk factors for falls are broadly categorised into two factors—‘extrinsic and intrinsic’ and while the effect of functional mental health conditions on falls has not been extensively studied, older adults with dementia are at a higher risk of falling. Their impact could lead to delayed functional recovery, distress, increased length of hospital stays and an increased fear of falling.

Quality improvement (QI) methods have been demonstrated as one strategic approach to reducing falls in mental health older person wards. We completed QI work at Surrey and Borders Partnership NHS Foundation Trust, to reduce fall incidents in Victoria Ward—an older person ward treating people with functional mental health disorders. We generated a theory of change and then tested several change ideas developed by the team. Using this approach, outcomes resulted in a reduction in the rate of falls from 9.5 falls per 1000 bed days to 4.6 falls per 1000 bed days.