Yasan, Caglayan (2022) Falls Prevention for Inpatient: A Case Study. PhD thesis, Victoria University.

Abstract

The incidence of falls and serious injuries related to patient falls in hospitals is on the rise. This situation could potentially result in serious injuries and even death for the patient, as well as financial burden for acute care hospitals and increased workloads and stress for nursing staff. The incidence of falls in the metropolitan acute care hospital medical ward where this study was conducted continues to be problematic. This research study investigates the factors that cause patient falls in order to maintain and enhance sustainable falls prevention management. The falls risk assessment tool used in the hospital was part of the 6-PACK Falls prevention program for patients that was developed in 2002. A mixed method case study was employed for the research. Data was collected from a medical ward in two phases: Phase 1 analysed the quantitative falls data from the hospital RiskMan software tool and Patient Centred Care Plan (PCCP). This analysis informed the development of the qualitative research in Phase 2 which included the nurse questionnaire and nurse focus group discussions, as well as patient interviews to examine the complexities involved in falls management prevention. The triangulation of nurse and patient viewpoints of the falls prevention program, together with the administrative (RiskMan, PCCP) data, provides a fuller exploration of the contributing factors and adds to the body of knowledge in this important area. The Donabedian model of structure, process and outcome (SPO) was adapted to form an Inpatient Falls Prevention model that could be effective in the analysis of all aspects of patient care. The data collected in the quantitative and qualitative phases was analysed using this Inpatient Falls Prevention model. The case study identified that there were a significant number of patients whose falls risk assessment was not documented as part of their daily care plan. This resulted in high-risk patients not having falls prevention strategies implemented in their nursing care. For cognitively impaired patients falls were much higher for several reasons, including patient-nurse ratios, time challenges and issues surrounding the management of patients with dementia, delirium, and behavioural issues. The ward and bed layout, equipment malfunction, lack of patient education, and engagement in their falls prevention plan were also identified as contributing factors to inpatient falls. This study found that nurses failed to properly implement falls prevention strategies and management in the medical ward, and makes a number of recommendations for the benefit to all stakeholders - the healthcare system, hospitals, nurses, and most importantly, the patients. There is an increased need for professional development of nursing staff to identify and document patients at risk of falls and to modify the falls risk assessment tool. Patients need to be more actively engaged in their falls prevention plan and there needs to be better stakeholder communication: nurse to nurse, nurse to patient and nurse to allied health professionals. In addition, there is a need for more frequent PCCP auditing and immediate feedback to nursing staff. In this way, nurse knowledge of patient assessment, falls documentation and implementation strategies would assist in increasing patient safety and enhancing their hospital experience.

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