Abstract
Introduction
Old age psychiatry wards facilitate patients who have physical health needs alongside mental health needs, deeming them high risk for falls. Following a fall, best practice suggests a doctor should perform a medical review. An audit of this was performed within the Harplands Hospital in-patient elderly care psychiatric ward, which revealed incomplete documentation or the absence of a review. Subsequently, a post-falls proforma was implemented and a re-audit was performed.
Method
Audit cycle one gathered data on post-falls documentation between August and September 2020. A falls proforma was then introduced and cascaded to ward staff. Audit cycle two then gathered data on post-falls documentation between November and December 2021. Information collected included if falls occurred within normal working hours (Monday-Friday, 09:00-17:00), whether witnessed or unwitnessed, if an assessment was documented, whether a head injury occurred, whether anticoagulation status was documented, and whether neurological observations were completed.
Results
The first cycle showed a total of 31 falls. Insufficient documentation was recorded in 5 falls (16.1%), including 2 falls (6.5%) with no documentation of a physical assessment. A head injury was recorded following 25% of falls, with anticoagulation status documented in 100% of cases. The re-audit showed a total of 10 falls. All falls (100%) were reviewed by a doctor with documentation recorded, including a brief history and assessment. A head injury was recorded in 4 cases (40%), with anticoagulant status only being documented in one case (25%).
Conclusion
This audit demonstrated the implementation of a falls proforma improved post fall documentation. It was noted that the falls proforma was not always utilised, which was thought to be due to junior doctor rotational changes alongside lack of communication regarding this tool. Moving forward, this second cycle identified the need for proforma digitalisation and junior doctor education at induction.