Falling in Acute Mental Health Settings for Older People : Who falls, where, when and why?

Copyright: © 2014 Dickinson A et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Falls, slips and trips are a major patient safety concern in hospital settings accounting for 26 per cent of all reported patient safety incidents in England. Mental health conditions and their treatments add further to fall risk but we have little information regarding who falls, where and when within mental health settings. Methods: This paper presents an overview of the pattern of falls by older patients within an in-patient mental health setting in the South of England using routine records completed by staff when a fall occurs. 920 fall reports over three years were analysed, and 7 focus groups were undertaken with ward staff to explore how staff understood falls and their experiences of using the falls reporting system. Results: In terms of diagnosis 40% of fallers had a primary functional diagnosis, 46% an organic mental health diagnosis (14% non-specific diagnosis), average age was 81.7 years (range 59 to 99 years; SD 8.3) and 57% were female. Approximately one quarter, 27%, of falls were observed by staff. Falls were not evenly distributed across either day of week or time of day, with peak times for falls on Tuesday and Saturday and morning (7-8 and 9-10am) and subsidiary peaks between noon and 1pm and early evening (5-6pm). Almost half of falls occurred in private spaces in the ward such as bedrooms, and 42% in public spaces such as sitting rooms. However 60% of falls in public spaces were unseen. Reporting in these settings was problematic for staff and patients were sometimes described as placing themselves on the floor as a consequence of their mental health condition. The average time to first fall was 5 weeks. Conclusions: Routine mapping of falls could be undertaken at ward and organization level and contribute to better understanding of the local factors contributing to falls. Exploring incident report data in focus groups with staff helped us and them to interpret the data and to understand some of the decision making staff engage in everyday when reporting falls.Peer reviewedFinal Published versio

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Evaluating falls in inpatient mental healthcare settings for older people : Methodological Triangulations & Tribulations

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Communities with oomph? : What can older people’s engagement in the local governance of neighbourhood renewal tell us about their potential role in a Big Society?

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Falls screening and assessment tools used in acute mental health settings : An analysis of polices in England and Wales

Background: There is an urgent need to improve the care of older people at risk of or who experience falls in mental health settings. Falls are the most frequently reported patient safety incident. NICE Guidelines recommends the use of multidisciplinary fall risk assessment during individualised treatment and in prevention care plans for older people at risk of falls (NICE, 2004). This poster outlines work underway to explore the policy guidance issued by NHS Mental Health Trusts in England and Health Boards in Wales. Methods: We requested fall policies and other relevant documentation from NHS mental health trusts in England (56) and healthcare boards in Wales (6). Policies are being subjected to a quantitative content analysis to explore guidance given to clinical staff and managers. Findings: We obtained falls policies from 42 mental health trusts in England, and 2 from healthcare boards in Wales. 30 policies were publically available on the internet. 1 Trust told us they did not have a fall-prevention strategy. 1 was currently reviewing their policy. Analysis of fall risk assessment tools show variation in the number of risk-variables included. Few Trusts used validated tools such as STRATIFY, FRASE, MORSE, and MHOA, others used customised falls risk assessment tools. Conclusions •A wide variety of screening and assessment tools are in use, however, the most commonly used are those developed by individual Trusts, or which focus solely on the external environment, with no screening/assessment of individual patients. •Use of invalidated tools raises questions of reliability and effectiveness.Non peer reviewedFinal Accepted Versio

The temporal and spatial nature of falls in acute mental health settings

Introduction: Falls are the most commonly reported patient-safety incident in mental health settings for older people with approximately 36,000 falls reported from these settings per year. Risk of falling is exacerbated by mental health problems, such as impaired mental status due to dementia and depression, and their treatments. However, we have very little understanding of either the context or best way to prevent falls in these settings. This paper will present phase 1 findings from a mixed-methods exploratory case study. Methods: Methods included retrospective analysis of reported falls for a 12 month period, non-participatory observation (300+ hours), focus-groups with staff (n=5) and interviews with senior managers (n=6). Findings: We will use the data to explore the temporal and spatial nature of falls within 5 acute mental health settings. We found falls were not evenly distributed across the course of the day, with peaks occurring in the morning, and early afternoon. Staff reflections on this data during focus group discussions, and our observations of the temporally-determined flow of activity and use of space by staff, patients and visitors to the ward have enabled us to understand some of the patterns and possible factors that contribute to falls in these settings. Conclusions: Use of routinely collected data, enhanced by staff reflection and observation can aid understanding of factors contributing to falls in acute mental health settings. Data of this nature could be used by organisations seeking to manage risk, improve patient safety, and develop appropriate interventions.Non peer reviewe

Preventing and managing falls among people with mental health problems

Background: Falls are a leading cause of mortality and morbidity in older people and these risks are exacerbated by mental health conditions such as depression and dementia. Previous reviews have focused on people with dementia and cognitive impairment, but not those being cared for with other mental health conditions or in mental health settings. Objectives: To evaluate the effectiveness of fall prevention interventions for older people with mental health conditions. Methods: We conducted a systematic review of fall prevention interventions for people aged 65 and over in both inpatient and community health settings providing care for patients with mental health conditions. We searched a range of electronic databases and undertook lateral searches to identify both controlled and uncontrolled studies. Studies were assessed for risk of bias on six domains. Due to heterogeneity results were not pooled but are reported narratively. Results: Fifteen studies met our inclusion criteria. Interventions that include multifactorial, multi-disciplinary interventions and those involving increasing staff awareness appear to reduce the risk of falls but the evidence is mixed and quality of the studies varied. Only 2 studies, both undertaken in the US, were undertaken in mental health settings. We found no data relating to process outcomes or patient views. Conclusion: The review provides evidence that fall prevention interventions can be effective in preventing falls in older people with mental health problems. There is a dearth of falls research undertaken in mental health settings or which focus specifically on patients with mental health problems.Non peer reviewedFinal Accepted Versio

An analytical review of local and national fall policy and guidelines

The prevalence of falls in the United Kingdom is high with 1 in 3 people aged over 65, and 1 in 2 people over the age of 85 falling each year. The potential for older people to fall is exacerbated by mental health problems, such as impaired mental status, depression, dementia, and treatment with psychotropic medication. As such, the National Patient Safety Agency has recommended that NHS organisations understand and acknowledge the high risk of falls in older people using mental health services and use local reports of falls to target and assess their fall prevention strategies. One of the aims of this study, funded by NIHR Research for Patient Benefit is to analyse current local and national falls policy and guidelines specific to mental health settings. We will present an analysis of national falls policy and guidelines, aligned with corresponding documents from all Mental Health Trusts (n=56) in England and Wales which will be collated and analysed to enable extrapolation of factual information on how Trusts interpret and implement the evidence-base. Comparison between the Trusts will also be presented. The poster will also include data collected detailing specific processes that Trusts have implemented to reduce falls incidence. We will also present a 'content analysis', to identify specific themes or concepts 'tested' and 'defined' within and between the different documentation. This poster presents research in progress.Non peer reviewe

Preventing and managing falls among older people with mental health problems : a systematic review

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