News
Reducing Falls: A Douglas Solution
2007-02-28
Can we reduce the number of falls in the elderly patient population?
A combination of stricter guidelines and a homegrown falls assessment tool may do the trick.
A Priority
In recent years, the Douglas has made it a priority to reduce the number of falls suffered by patients in the Geriatric Psychiatry Division. According to Michel Laverdure, clinical-administrative chief of the Geriatric Psychiatry Psychosocial Rehabilitation Unit, there are many reasons for this decision, “Falls cause pain, anxiety, and severe injuries like hip breaks or fractures. They can lower patients’ long-term quality of life—as well as their life expectancy. Falls can also keep us from treating the patients in greatest need. When a patient, who no longer needs our specialized psychiatric skills, uses one of our beds because of an injury, other patients must remain on the waiting list.”
Stricter Guidelines
The first step in reducing falls has been to establish a clear definition of a fall, to be used throughout the Douglas. Until recently, falls could be defined differently from unit to unit, making the reporting process unreliable. In 2005, a precise definition of a fall was approved by Comité novateur sentinelle de la prévention des chutes (CONSEP)—a Geriatric Psychiatry Division committee responsible for developing and applying best practices in the area of falls prevention.
The CONSEP committee noted a rise in reported falls between 2003 and 2006. Michel Laverdure confirms that this has likely resulted from 1) the lack of a hospital-wide falls assessment approach; 2) the use of a tool intended for a long-term care facility population; 3) the fact that the geriatric psychiatry patients Douglas now serve have more acute physical and psychiatric problems than in the past. In recent months, these numbers seem to have stabilized—a trend the Douglas wishes to continue.
A Better Tool
The second step in reducing falls has been to create an assessment tool to accurately pinpoint all patients at high, moderate and low, but significant, danger of falling. This initiative was taken in response to a discovery made by Clinical-Administrative Chief Michel Laverdure and his team in 2003. They found that the popular assessment tool they had been using to record falls was inaccurate. It had failed to uncover 18 percent of patients at a reduced, but significant, risk of falling. Seeing an opportunity for innovation, Michel Laverdure and researcher Natasha Rajah, PhD, from Douglas Research Centre, joined forces to create a new assessment tool. They named it the Geriatric Psychiatry Fall Risk Assessment Tool (GP-FRAT).
As of November 2006, the tool is in the testing stage. A four-person team is conducting a trial of the GP-FRAT assessment tool with 150 geriatric psychiatry patients. Two of the staff are using the older assessment tool and two are using the GP-FRAT to determine which is more precise. The CONSEP Committee will review the results in 2008.
Exciting Potential
If the current study indicates that the GP-FRAT is superior, the application potential is enormous. Keen interest has already been demonstrated by other psychiatric hospitals, long-term care institutions, and other facilities where falls are a major concern.
Another plus: the GP-FRAT’s use need not be limited to a geriatric psychiatric clientele. Adult patients of all ages, with or without psychiatric disorders, may benefit.
All involved look forward to the trial results with intense interest.
Picture - Our CONSEP TEAM (from left): Louise Laflamme, Nurse; Louise Beauvais, Specialized Clinician-Nurse; Michel Laverdure, Clinical-Administrative Chief, Maureen Stafford, Social Worker; A Trainee; Danielle Thisdale, Senior Clerk. Absent: Linda Derouin and Natalie Strychowsky, Occupational Therapist
A combination of stricter guidelines and a homegrown falls assessment tool may do the trick.
A Priority
In recent years, the Douglas has made it a priority to reduce the number of falls suffered by patients in the Geriatric Psychiatry Division. According to Michel Laverdure, clinical-administrative chief of the Geriatric Psychiatry Psychosocial Rehabilitation Unit, there are many reasons for this decision, “Falls cause pain, anxiety, and severe injuries like hip breaks or fractures. They can lower patients’ long-term quality of life—as well as their life expectancy. Falls can also keep us from treating the patients in greatest need. When a patient, who no longer needs our specialized psychiatric skills, uses one of our beds because of an injury, other patients must remain on the waiting list.”
Stricter Guidelines
The first step in reducing falls has been to establish a clear definition of a fall, to be used throughout the Douglas. Until recently, falls could be defined differently from unit to unit, making the reporting process unreliable. In 2005, a precise definition of a fall was approved by Comité novateur sentinelle de la prévention des chutes (CONSEP)—a Geriatric Psychiatry Division committee responsible for developing and applying best practices in the area of falls prevention.
The CONSEP committee noted a rise in reported falls between 2003 and 2006. Michel Laverdure confirms that this has likely resulted from 1) the lack of a hospital-wide falls assessment approach; 2) the use of a tool intended for a long-term care facility population; 3) the fact that the geriatric psychiatry patients Douglas now serve have more acute physical and psychiatric problems than in the past. In recent months, these numbers seem to have stabilized—a trend the Douglas wishes to continue.
A Better Tool
The second step in reducing falls has been to create an assessment tool to accurately pinpoint all patients at high, moderate and low, but significant, danger of falling. This initiative was taken in response to a discovery made by Clinical-Administrative Chief Michel Laverdure and his team in 2003. They found that the popular assessment tool they had been using to record falls was inaccurate. It had failed to uncover 18 percent of patients at a reduced, but significant, risk of falling. Seeing an opportunity for innovation, Michel Laverdure and researcher Natasha Rajah, PhD, from Douglas Research Centre, joined forces to create a new assessment tool. They named it the Geriatric Psychiatry Fall Risk Assessment Tool (GP-FRAT).
As of November 2006, the tool is in the testing stage. A four-person team is conducting a trial of the GP-FRAT assessment tool with 150 geriatric psychiatry patients. Two of the staff are using the older assessment tool and two are using the GP-FRAT to determine which is more precise. The CONSEP Committee will review the results in 2008.
Exciting Potential
If the current study indicates that the GP-FRAT is superior, the application potential is enormous. Keen interest has already been demonstrated by other psychiatric hospitals, long-term care institutions, and other facilities where falls are a major concern.
Another plus: the GP-FRAT’s use need not be limited to a geriatric psychiatric clientele. Adult patients of all ages, with or without psychiatric disorders, may benefit.
All involved look forward to the trial results with intense interest.
Picture - Our CONSEP TEAM (from left): Louise Laflamme, Nurse; Louise Beauvais, Specialized Clinician-Nurse; Michel Laverdure, Clinical-Administrative Chief, Maureen Stafford, Social Worker; A Trainee; Danielle Thisdale, Senior Clerk. Absent: Linda Derouin and Natalie Strychowsky, Occupational Therapist
