Fall prevention is important among seniors who are prone to falls. This preventive measure is useful not only at home, but also in a residential setting.
Serious injuries can result from falls. In certain instances, they may lead to a loss of independence that may affect a senior’s quality of life. At times, there is also the potential loss of morbidity.
A study showed that falls in healthcare institutions that provide care for persons with mental health conditions were significantly more common as compared to other healthcare settings. (Meng, Sim, Pee, Kwok & Ng, 2010). St. Andrew’s Nursing Home (Buangkok), which serves residents who have dementia and stable psychiatric conditions, houses a majority of residents aged above 60. This study motivated the team to embark on the “Keeping Falls At Bay, The Care Bundle Way!” project in 2019.
With the residents’ well-being at the core, the project aimed to improve clinical quality and patient safety within the nursing home. Putting the plan in motion, the project team initiated a care process that assessed the fall risk of the residents. The intent was to introduce appropriate care plans and preventive measures to prevent falls.
Customising The Fall Intervention Plan
Determined to bring about improvements in fall prevention and management, the project team analysed the data collected from incidents occurring between January and June 2018. What stood out as the common risks factors for falls were:
- Poor safety awareness
- Altered mental state
- Underlying medical conditions
- Frailness in the residents
With the findings foremost in the minds of the project team, they formulated a care bundle that mapped out an intervention plan to better manage the residents’ fall risks and commenced a trial in a ward within the Nursing Home.
The care bundle was nuanced, which led to the development of three sections of care interventions
- “Must Do Care Bundle”
- “Good To Do Care Bundle”
- “To Do Situational Care Bundle”
"Must Do Care Bundle"
The “Must Do Care Bundle” is a mandatory care protocol that must be performed for all residents in the ward. This bundle includes a Fall Risk Assessment Tool (FRAT), which is a form that screens a senior’s history of falls in the past year, medication, peripheral sensation, strength and balance.
For new admissions to SANH (Buangkok), FRAT and other visual assessments are conducted on new residents within 24 hours of admission. Under this care bundle, there are specific roles for occupational therapists, nurse managers, physiotherapists and pharmacists.
"Good To Do Care Bundle"
The “Good to Do Care Bundle” outlines a care protocol whereby the care team takes note of residents' physical needs and update the Project Team on any falls within the wards. A fall committee was also set up by the Project Team, comprising nurse leaders and care staff, to monitor the progress in this care bundle.
"To Do Situational Care Bundle"
The “To Do Situational Care Bundle” is a care protocol that is performed on a case-by-case basis. The care team monitors residents' vital signs and supervise the residents’ reactions to any change in medication. Specific tasks are assigned to nursing aides, healthcare staff and nurses in this care bundle.
Expanding The Project Within SANH
The project was first implemented in ward 3A in January 2019. By September 2019, the care bundle was implemented in all the other 9 wards in SANH (Buangkok). The project has benefited both the residents and staff. Besides enhanced safety for residents, the training provided for staff has equipped them with the skills on using the fall assessment tool and improved their competency in transfer techniques.
To further ensure the consistency of the care bundle at SANH (Buangkok), all staff in the wards were also audited every six months on staff knowledge, environment and compliance to Fall Prevention Standard Operating Procedures. Additionally, regular meetings were held to address the challenges encountered by the team.
Making this project a success was the positive attitude of the care team members at St. Andrew’s Nursing Home (Buangkok). They complemented the Project Team which through its strong leadership piloted the care bundle smoothly by overcoming any prevalent challenges. The unity between the staff and the firm support from the Management were instrumental in helping SANH (Buangkok) achieved the desired outcomes.
“It was indeed a challenge to achieve our goals, considering the profile of our residents. With strong leadership to ensure enforcement of the care bundle, alongside the positive attitude of our staff, the word ‘impossible’ became ‘possible’ for the team.”
Madam Theresa Lein, Assistant Director of Nursing at SANH (Buangkok)
About St. Andrew’s Nursing Home (Buangkok)
Established in November 2013, SANH (Buangkok) is a nursing home that provides long-term residential care for 300 residents with mental health conditions and dementia. Being a non-profitable, voluntary welfare organisation, they pride themselves on the provision of holistic and person centered nursing care to all their residents. With a team of more than 160 staff, SANH (Buangkok) engages residents in rehabilitative and vocational training. Find out more about SANH (Buangkok) here.