Abstract
Introduction:
Falls account for 17% of emergency department (ED) attendances and cause significant morbidity and mortality in older people. An accurate falls risk assessment can identify those at risk of inpatient falls. At Northumbria Healthcare NHS Foundation Trust, the ‘Avoiding Falls Level of Observation Assessment Tool’ (AFLOAT) was developed to identify patients requiring higher levels of observation to prevent falls (Richardson DA. ClinMed (Lond). 2020; 20(6): 545-550). Whilst AFLOAT was commonly used for inpatients, it was rarely completed in ED. A multi-disciplinary and inter-speciality group was formed from ED and Geriatric Medicine teams aiming to improve falls risk assessment for elderly patients within ED.
Aim:
To improve completion of AFLOAT to >70% for patients >75 years admitted to ED
Method:
Of ED attendees > 75 years from RCEM QIP data, 6 patients were randomly selected daily from December 2023 - January 2024 to assess AFLOAT completion. Those attending during the Holiday period and NEWS scores >6 were excluded. Educational interventions were implemented in January 2024 involving face-to-face teaching for all clinical staff in ED and posters placed in the ED seminar room. Data was re-collected for February 2024 and is ongoing for subsequent months. Results: 19.12% of patients had AFLOAT recorded between December 2023 – January 2024. Following our interventions, in February 2024 AFLOAT completion rates rose to 24.69%.
Conclusions:
Whilst improvement has been seen after interventions, we have not yet achieved our target of 70%, suggested ongoing actions: • Questionnaire amongst ED staff on AFLOAT to promote familiarity and look for reasons for incompletion. • Add an electronic prompt into clerking and falls proformas. • We have asked technicians to remove a comment on AFLOAT implying that it should only be completed by nurses. • Attend Junior Doctor inductions to broadcast completion of AFLOAT. Ongoing PDSA cycles in progress.
Comments
Question
Hello and thank you for presenting your work. Although it is disappointing that there was not an improvement in completing the AFLOAT falls risk assessment, it is pleasing that you are trying to identify barriers to it being completed, in order to address them. What does the AFLOAT risk assessment entail, e.g. what questions are asked? How long would it take to complete an assessment?
Thank you for the question Dr McRae. Perhaps we should have mentioned that in our discussion but the assessment is very quick.
The Trust uses personal mobile phones/tablets for all staff which has the electronic obs/NEWS/assessments app and it's a simple press of a few buttons to complete the assessment within this app. The questions to answer simple things which would have been covered in even triage in ED, and especially in a clerking (previous falls, new or old cognitive impairment)
Many thanks for your question.
The AFLOAT tool gives points for each the following;
Negative points are given if the patient is completely mobile or unconscious.
The tool itself takes a couple of minutes to complete at the patient bedside using handheld eletronic devices. Or if the information is known/documented it can be completed remotely by any member of staff. The tool can be resubmitted if new information comes to light.