Preventing falls in the acute hospital setting.

A sequential crossover design with a 20 week data collection period has been adopted. An A/B design is proposed with Phase A being non-intervention and Phase B – intervention. There are four components: 1.Research protocol standardisation training (e.g. what is a fall, what is an injurious fall, how do I report etc.) – this will ensure consistent data across both phases 2.Phase A – Pre-intervention data collection (10 weeks) 3.Intervention training 4.Phase B – Intervention data collection (10 weeks) Education - All staff will attend meetings 1-2 days prior to each phase to be trained in research protocol standardisation and research interventions The following interventions will be implemented for the duration of person’s admission within the 10 weeks of the intervention phase: Falls Risk Flagging - Every admission will be screened (Have you had a fall in the last 12 months? Observe the patient stand from a chair, walk a short distance and return to sitting) and/or assessed (The Northern Hospital Modified Stratify Falls Risk Assessment Tool) as part of usual care. In the intervention phase falls risk will be flagged using an orange High Falls Risk Alert Sign on the person’s door, above the bed and on their walking aid. The person will also wear an orange arm band Mobility and walking aids - Physiotherapy review will be undertaken on the morning of admission for people at high risk of falling. The physiotherapist will conduct a Timed Up and Go Test, issue an appropriate walking aid where indicated and conduct ongoing mobility and balance training as indicated. Footwear – people at high risk of falling will be assessed by the admitting nurse for appropriate footwear as outlined in Australian Falls Prevention Guidelines. Those without appropriate footwear will be offered non-slip socks (GripSox™) for walking. Medications - No new Benzodiazepine will be prescribed by any medical officer without consulting the hospital’s Consultant Physician. Hydration Programme - Hourly water cues and toileting offers will be made during waking hours for cognitively impaired participants (i.e. defined as person’s with an Abbreviated Mental Test Score of <8). Water fountain with a “park bench” and reading material will be located on each ward as a place for wandering people to go. A “Happy Hour” where non-alcoholic mocktails, soft drinks, cordial and nibbles are served will be held 1-2 times per week and it will be targeted towards cognitively impaired people to improve hydration. Supervision and surveillance - High Falls Risk Patients will never be left alone in the bathroom Environment – A 7pm Light round will be conducted where all bathroom lights will be turned on in at night where no sensor light is fitted. Fracture prevention - Hip protectors will be offered to anyone admitted with a low trauma fracture or anyone who has a diagnosis of osteoporosis Vision - Patients are offered their own appropriate spectacles for every walk. Low beds and appropriate height chairs – A breakfast bed and chair height round will be conducted where beds and chairs are set to popliteal crease height or lowest height, and meal tables will be placed within reach.