UPRIGHT
Falling in Hospital has Serious and Negative Consequences: Falls in hospitals are common and costly. AI Hill has previously reported that fallers with dementia and delirium had longer average length of stays (ALOS) and costs than age, gender and Diagnostic Related Groups (DRG) matched non fallers. A UK report examining 200,000 incident reports over 12 months found that inpatient falls were the most common (40%) type of safety incident reported. In this report, falls were said to be directly responsible for 26 patient deaths, 530 hip fractures and about 1000 other fractures. The psychological consequences of falls to the individual include anxiety, depression, loss of confidence and fear of falling and ultimately a downward spiral of decline in health. The occurrence of a fall also impacts negatively on staff and family resulting in feelings of fear, guilt, anxiety, defensive actions and at times these contribute to conflict and result in complaints, coroner’s inquests and litigation.
Older Patients and Those with Dementia or Delirium are Major Consumers of Hospitals: It is well documented that older patients and those with dementia or delirium are at increased risk of falling. In a retrospective observational study by AI Hill of a 323-bed acute care tertiary hospital, Dementia (B63Z) and Delirium (B64Z) were the Diagnostic Related Groups (DRGs) with the highest proportion of fallers, with up to 24% of patients admitted with those DRGs experiencing a fall in acute care. This same study also demonstrated that falls were most common in the oldest (i.e. age >80 years)1. Older people are major consumers of healthcare. Even though people aged 65 years and older make up only 15% of the population in South Australia, they account for 38% of hospital separations and 51% of all inpatient days (SA Health Policy for Older People-2010-2016). A recent unpublished audit (CI Visvanathan) of in hospital fallers within the Division of Medicine at the Queen Elizabeth Hospital in Adelaide confirms that 68% of falls occurred in those aged 75 years and over and almost half of these patients falling had dementia or delirium.
Where do People Fall in Hospital?: In hospital, falls commonly occur around the patients’ beds, in the corridor, bathroom and/or the toilet. A study of an older persons unit revealed that 66% of falls occurred in the bedroom with 80% of these falls occurring around the bed. Many falls occur at night when nurse staffing levels are lowest and patient confusion occur. In one study, over 54% of the bedroom falls in an older person’s assessment, treatment and rehabilitation unit were un-witnessed. Similarly, in our hospital audit, 54% of falls were un-witnessed. 71% occurred in the bedroom and 17% in the bathroom. 35% were whilst ambulating and 25% were related to sitting or standing.
What we are doing about it?: There is a definite need for effective, evidence based interventions in hospitals, especially for older patients and those with cognitive impairment as highlighted in a recent systematic review and meta-analysis.
Therefore primary aim of this study is to determine the feasibility of a movement sensor alarm intervention using radio-frequency identification (RFID) technology to alert staff to a falls risk within a hospital geriatric unit. Feasibility aspects studied include: a) the acceptability of the intervention to consumers (including carers and patients with dementia) and clinicians; b) safety of the system to patients with dementia; c) adherence to the intervention as evidenced by activation of the system and response to the alarm by clinicians; and d) participation (i.e. proportion participating) of eligible patients in the trial, barriers to participation and reasons for withdrawal. Secondary aims include: a) Acquiring local data to enable accurate sample size calculations to inform the design of a definitive cluster randomized control trial; and b) refining the technological system based on feedback from consumers and clinicians ensuring that the system is prepared for a definitive trial.
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