Stepping forward: A quality improvement project to improve post-falls assessment and management on old age psychiatric wards.

Introduction: Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by underlying mental health conditions and associated treatments. NICE recommends that people who fall should undergo multifactorial assessment including a post-fall protocol with assessment for injury before being safely moved, a timely medical examination (within a maximum of 12 hours or 30 minutes if fast-tracked), neurological observations (if there is suspicion of head injury or unwitnessed fall) and a medication review. Aim: We aimed to assess the quality of post-falls assessment and documentation in order to identify areas for improvement to reduce potential harm from injuries and implement strategies to reduce further falls. Methods: We identified ten falls over a 3-month period on two old age psychiatric inpatient wards. Data collected from e-notes was analysed for assessment for injuries, medical review, neurological observations and medication review. We also looked whether patients had OT/Physio input post-falls and MDT discussion to determine the likely cause for fall. Results: Only 40% of patients had a medical assessment completed within 12 hours. There was suspicion of head injury in 40% of patients but none of them had neurological observations completed. In 20% of falls, an MDT discussion took place to determine likely cause of fall and patients had their medications reviewed post-falls. Almost 90% had OT/physio input post-falls. Conclusion: We have since conducted a survey among healthcare professionals to identify common knowledge gaps that can be targeted to improve quality of care post-falls and conducted teaching sessions on relevant themes. Feedback has showed participants confidence has significantly improved in post-falls assessment. We have also created a weekly falls review meeting and designed and displayed a post-falls board with all necessary information. We aim to re-audit our practice now that changes have been implemented.