Abstract
Background:
OPAL Team cares for elderly patients arriving at hospital front door. 80% of referrals to OPAL team are related to Falls. Early assessment and intervention reduce future risk of falls improving health outcomes. OPAL assessment proforma used for falls assessment varies widely depending on local resources. In our trust Multifactorial risk assessment (MFRA) is included in OPAL proforma to assess any patient presenting with a fall or has had two or more falls in the past six months or needs hospitalisation due to fall. Our MFRA includes assessment of Vision, Continence, Cognition, Footwear, Medication review, Lying Standing Blood Pressure (LSBP), Range of Movement (ROM), Strength, Gait, Balance, and Functional assessment.
Methods:
A retrospective review of health records of 100 patients seen by OPAL in June 2022 assessed compliance with MFRA. This revealed 100% compliance in documenting patients falls history but only 20% had vision assessment, 17% Footwear assessment and 40% has LSBP checked. Emphasis on adherence to proforma and regular departmental teaching targeted toward components of MFRA was held every month during this study period (June 2022-June 2023). The retrospective audit was repeated in June 2023 after these interventions.
Result: Visual assessment improved from 20% to 66%, footwear from 17% to 60%, LSBP increased from 40% to 53% but there was decrease in assessment of ROM 67% to 38%, Strength 71% to 44%, and Balance 71% to 60. While other components assessment was around average 75%.
Conclusion: Reduction in some MFRA risk factors is relating to time and space constraints in ED environment. A dedicated OPAL assessment area in ED is anticipated to improve these parameters. Reinforcement in MDT meetings, buddy system for fresh staff and adherence to proforma for documentation will help in achieving 100% in all components.
Comments
Question
Hello and thank you for your poster. Your work shows good improvements in comprehensive falls assessment risk factors - after identifying risk factors how do the team progress in addressing them to help someone reduce their falls risk. And how do you envisage improvement adherence to the pre-existing pro forma?
Thank you for your question.
Once risk factors are identified, we consider individual patient factors and actively involve the patient in fall prevention strategies. This includes addressing any underlying medical causes, such as infections that may lead to delirium or reversible causes of postural hypotension. We also collaborate with community and specialist teams, making appropriate referrals to services like balance clinics or optometrists as needed. Additionally, patients receive information leaflets on key topics, such as proper footwear and managing postural hypotension.
To enhance adherence to the existing pro forma, we have implemented several measures. New staff members are trained on its use, and a buddy system has been introduced for additional support. We have printed copies of the pro forma, attached to clipboards for easy bedside use during assessments. Furthermore, an electronic version is available on the intranet's SharePoint, allowing staff to document assessments efficiently.We also provide reminders, ensuring all aspects of the multifactorial assessment are completed and documentation remains standardized.