Patient
Safety
Safety
What NSQHS Standard ensures that thew risks of harm for patients during health care are prevented and managed? (minimises harm through screening and strategies)
Standard 5- Comprehensive Care
What is the difference between intrinsic and extrinsic risk factors?
"Intrinsic risk factors are internal characteristics or conditions within an individual that increase their likelihood of developing certain health issues or injuries"
"Extrinsic risk factors are external influences or exposures that increase the likelihood of experiencing a negative health outcome or injury"
If a patient has had a fall while on the ward, what 6 forms of documentation is required?
1. DATIX CIMS
2. Documentation of fall in patient progress notes
3. Vital sign observations
4. Neurological observations
5. Rescreen FRAMP and Braden score
6. reassess and amend care plan
How long post fall must a medical review be completed post fall?
30 Mins
List 4 types of medications that could increase the risk of falls
1. Benzodiazepines
2. Antidepressants
3. Antipsychotics
4. Antihypertensives
5. Diuretics
6. Sedatives/ general anaesthetic
What type of patient needs a FRAMP completed on admission?
All patients!!
List 5 intrinsic risk factors
1. Urinary or faecal incontinence
2. Impaired cognition
3. impaired strength, mobility, gait or balance due to physical or neurological injury
4. impaired vision
5. Malnutrition from inadequate dietary intake
6. polypharmacy
What method of communication is used to handover to the medical officer post fall?
ISOBAR Handover
List 5 immediate actions post fall
1. Staff Asisst or MET call if patient meets crteria
2. Reassure patient
3. Complete A-E assessment
4. Informed MO, AHNM, CNM, Shift coordinator
5. Immobilise cervical spine if patient is unconscious or complaining of neck pain
6. commence neurologic and vital sign observations
7. Assess BGL, ECG, Neurological assessment, 4AMT
True or False: Antihistamines can increase you of risk of falls
True! Antihistamines often cause drowsiness which can lead to an increased risk of falls
List 4 interventions for a patient with GCS<15 who is a falls risk
1. Falls alarm mat
2. Regular checks/toileting
3. Re-orientation to time/place/person
4. MDT referral
5. Call bell within reach
6. De clutter environment
7. 4AMT
8. low low bed
List 5 extrinsic factors
1. Unstable furniture
2. Clutter
3. Poor Lighting
4. Use of restraints
5. Uneven or slippery surfaces
6. lack of staff/ poor surveillance and observation
7. Improper use of equipment
Who is to be notified after a patient has had a fall while in hospital?
1. MO
2. AHNM or CNM
3. Shift Coordinator
4. NOK
5. Allied health (OT, PT)
For patients who are on anticoagulants OR have had an unwitnessed fall, how often are you completed vital sign and neurological observations in the first 2 hours?
Half hourly for a minimum of 2 hours until GCS is 15
Continue if GCS remains <15 or patient considered not at baseline
what class of medications can pose serious complications post fall?
Anticoagulants
When should the use of bedrails be avoided?
For a confused patient who is able to climb, for patients with capacity who do not want them and for independent mobile patients
At what age are you at higher risk for a fall?
>65yrs or >45years for ATSI patients
Which form are patients individualised interventions and changes to mobility plan documented? Where on this form is this section located?
FRAMP
If the patient has a GCS of 15 and considered back to normal after the first 2 hours, what frequency of observations do we completed in the next 48 hours?
hourly for 4 hours
two hourly for 4 hours
four hourly for 40 hours (until 48hours)
Certain medications can decrease bone mineral density increasing risk of fractures or breaks. Can you name one medication that has this effect?
Corticosteroids
levothyroxine
Some epileptic medications (sodium valproate, phenytoin, carbamazepine)
What are the 4 questions asked on the initial falls risk screen?
1. Have you had a fall in the last 12 months?
2. Are you unsteady when walking/transferring OR do you use a mobility aid?
3. IS the patient confused, known cognitive impairment or answers any of the following incorrectly; age, DOB, current place and year
4. Do you have urinary or faecal frequency/urgency/nocturia
What are the 5 Risk Categories assessed on the FRAMP?
1. Mobility Risks
2. Functional Ability Risks
3. Medication/medical condition risks
4. Cognitive state risks
5. Continence/elimination risks
What situations requires a falls risk rescreen as per the FRAMP?
Ward admission, ward transfer, post fall, change in medical condition
What signs and symptoms would indicate a requirement for a head CT within the first hour post fall?
1. GCS<13 on initial assessment
2. GCS<15 at 2 hours post fall (not baseline)
3. Suspected open or depressed skull fracture
4. Any sign of basal skull fracture
5. Post traumatic seizure
6. focal neurological deficit
7. More than one episode of vomiting
What drop in blood pressure is classed as "postural hypotension"
20/10mmHg within 3 minutes