Paper
Thursday, July 12, 2007
Fall Prevention at General Hospitals in Singapore - A Strategy for Implementation of Clinical Practice Guidelines
Serena Siew Lin Koh, BSc, (Hons), Adv, Dip, (Midwifery), RN, Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore, Elizabeth Manias, RN, CertCritCare, BPharm, MNStud, PhD, FRCNA, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia, Alison M. Hutchinson, PhD, School of Nursing, The University of Melbourne, Melbourne, Australia, and Linda Johnston, PhD, BSc, Dip, N, RN, School of Nursing, University of Melbourne, Carlton, Australia.
| Learning Objective #1: Learn about and be aware of the fall incident and fall prevention practices in acute care hospitals in Singapore |
| Learning Objective #2: Understand the nurses' perceptions of the barriers to guidelines implementation in acute cate hospitals in Singapore |
SUMMARY
Falls are identified as a significant issue for patient safety in hospital settings. There is an imperative to effectively implement the Ministry of Health (MOH, Singapore) Fall Prevention Clinical Practice Guidelines (CPG). Implementation of CPGs requires a multi-faceted and tailored approach, recognizing both barriers to, and facilitators for, success.
AIMS
The aims of the study are: (1) to determine incidence of falls and explore fall prevention practices; and (2) to elicit nurses’ opinions regarding barriers to, and facilitators for implementation of clinical practice guidelines in their acute care practice settling.
METHODS
A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five general hospitals in Singapore. A survey was then conducted to assess nurses’ perception of barriers to change in their practice setting, using a validated self-administered questionnaire.
RESULTSNumber of fallers for all the hospitals was n=824. Analysis showed that patient fall rates ranged from 0.68 – 1.44 per 1000 patient days and fall-associated injury rates ranged from 24.4 – 71.7%. Use of a fall risk assessment tool by nurses was recorded in 76.9% of all nursing records. The highest percentage of barriers identified were: knowledge & motivation (85.4%); education (54.2%), supporting staff (81.4%) and facilities (72.3%).
CONCLUSION
This study has laid the foundation for further research for fall prevention in Singapore by describing current fall incidence, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results of this study are being used to inform the development of a multifaceted strategy with tailored interventions to support the implementation of clinical practice guidelines. Implementation of CPGs using an evidence-based approach should result in minimising the incidence of falls in acute hospitals in Singapore.