Page 74 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
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11 National QA Convention, 4 – 6 October 2022
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Reducing the Number of Falls among Psychiatry Inpatients, Hospital Sultan Haji Ahmad
Shah (HoSHAS), Temerloh

Meera M, Firdaus AG, Zuri Shahidii K, Kailash NN, Roslan S, Nur’Atiqah H, Ku Hafiz KAH, Mariani R
Psychiatry Department, Hospital Sultan Haji Ahmad Shah, Pahang

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Falls are a constant problem in psychiatry care. It jeopardises patients’ safety and hinders treatment recovery.
Psychiatry inpatient falls were highest in 2020 with a prevalence of 18% compared to 2019 (9%) and 2018
(15%). While falls are preventable, the existing recommendations are limited for Psychiatry. This study aimed
to mitigate falls through psychiatry-tailored interventions.

KEY MEASURES FOR IMPROVEMENT:
The indicator measured as the percentage of falls among Psychiatry inpatients in HoSHAS, with a standard of
<5% based on literature reviews.

PROCESS OF GATHERING INFORMATION:
A cross-sectional study was conducted from March-April 2021 to determine the contributing factors of falls
from 2018-2020. Data was extracted from incident reports of falls, hospital information system, Morse Fall
Scale, and census of falls in the past three years.

ANALYSIS AND INTERPRETATION:
Major factors responsible for falling were the complexity of clinical conditions (57%), lack of knowledge,
experience and skills of the staff (50%), and sedative effects of medications (50%). The ABNA before remedial
measures was 13%.

STRATEGIES FOR CHANGE:
Specifically designed fall prevention measures were carried out from May 2021-March 2022, followed by
re-evaluation in April 2022. A fall prevention team was established to coordinate the implementation. Staff
were trained using the Wilson Simms Fall Risk Assessment Tool (WSFRAT). Lectures on fall prevention and
psycho-education to patients on fall precautions were conducted. All admissions were assessed clinically with
WSFRAT as an additional tool. Patients with a higher risk of falling were closely monitored, and a fall alert
tag was placed on the board of patients’ information for reference. A designated doctor in charge of the ward
was assigned for continuous patient care, especially to ensure judicious use of long-acting benzodiazepines.

EFFECT OF CHANGE:
Falls reduced from 18% to 0% with ABNA -5%.

THE NEXT STEP:
Fall precautions will be continuously monitored to ensure the sustainability of the implementations. In the
future, patients at higher risk of falling shall be identified by different coloured hospital attire.

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