Posted: April 29th, 2018

Preventing falls in psychiatric facilities

Preventing falls in psychiatric facilities

Falls are a common and serious problem for patients in psychiatric facilities, especially older adults with mental health problems. Falls can cause physical injuries, psychological distress, increased length of stay, and increased healthcare costs. Therefore, preventing falls is a priority for patient safety and quality of care.

According to the literature, the best way to prevent falls in psychiatric facilities is to use a multifactorial approach that involves assessing and addressing individual risk factors, environmental hazards, medication effects, and staff education. A multifactorial approach can reduce falls by 20-30% compared to usual care [1] [2]. Some of the key components of a multifactorial approach are:

– Fall risk assessment and reassessment: This involves using a validated tool to identify patients who are at high risk of falling and reassessing them regularly or when there is a change in their condition or medication. For example, the FallSafe project used the STRATIFY tool to assess fall risk and recommended reassessment after any change in psychotropic medication [2].
– Fall prevention interventions: These are tailored to the specific needs and preferences of each patient and may include physical exercise, balance training, assistive devices, footwear, hip protectors, environmental modifications, bed alarms, patient education, and fall prevention protocols [1] [3].
– Bedside shift report: This is a communication strategy that involves nurses handing over information about patients’ fall risk and interventions at the bedside in front of the patient. This can enhance patient involvement, continuity of care, and staff accountability [2].
– Safety huddles: These are brief daily meetings where staff discuss patients’ fall risk and interventions, review fall incidents and near misses, and identify areas for improvement. Safety huddles can foster a culture of safety, teamwork, and learning [2].
– Dashboard system: This is a visual display of data on falls and falls prevention processes that can help staff monitor performance, identify trends, and set goals. A dashboard system can also provide feedback and motivation to staff [2].

Implementing these components as a care bundle can improve the delivery of multifactorial assessment and intervention and reduce fall rates in psychiatric facilities [2]. However, there are some challenges and barriers to implementing a multifactorial approach, such as staff resistance, lack of time and resources, competing priorities, patient non-compliance, and organizational culture [1] [3]. Therefore, it is important to involve staff and patients in the planning and evaluation of fall prevention strategies, provide ongoing education and support, and use quality improvement methods to facilitate change [1] [2] [3].

In conclusion, preventing falls in psychiatric facilities requires a multifactorial approach that addresses individual, environmental, medication-related, and organizational factors. A care bundle that incorporates evidence-based components such as fall risk assessment and reassessment, fall prevention interventions, bedside shift report, safety huddles, and dashboard system can improve patient safety and quality of care. However, implementing such a care bundle requires overcoming some challenges and barriers by engaging staff and patients, providing education and support, and using quality improvement methods.

References:

[1] Bunn F et al. Preventing falls among older people with mental health problems: a systematic review. BMC Nursing 2014; 13:4. https://doi.org/10.1186/1472-6955-13-4

[2] Healey F et al. Falls prevention in hospitals and mental health units: an extended evaluation of the FallSafe quality improvement project. Age Ageing 2014; 43(4):484-491. https://doi.org/10.1093/ageing/aft190

[3] Strom J. Falls Risk Prevention Bundle to Reduce Falls in an Inpatient Psychiatric Unit. Int J Nurs Health Care Res 2022; 5:1328. https://doi.org/10.29011/2688-9501.101328

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