P132: Developing and piloting a nurse-initiated falls risk screening tool in the emergency department

Abstract

Introduction / Innovation Concept: With aging, increasing complexity, and prolonged emergency department (ED) stays, patient falls are an increasing problem. Accreditation Canada recently listed falls risk management (FRM) as a required operational practice (ROP). The University of Alberta ED had no screening tool or education program specific to falls. Gaps in identifying patients with altered consciousness, intoxication, or are undergoing procedural sedation were noted in the Alberta Health Services (AHS) recommended tool. This gap led to the development piloting of an ED specific FRM screening tool. Methods: A literature review was completed to assess current fall assessment tools and their applicability to the ED. No ED specific tools were identified leading to the development of the FRM tool. Prior to the FRM tool being piloted, nursing staff were asked to respond to a voluntary survey on their perceived knowledge of falls management followed by a survey testing their actual knowledge. They were then educated on the FRM and protocol through in-services, power point presentations, and fact sheets. A post education knowledge survey was then sent out. Multidisciplinary working groups provided feedback throughout the pilot, resulting in modifications prior to final implementation. Curriculum, Tool, or Material: The FRM tool consists of 10 variables with a maximum score of 20. Variables included are: falls in the last 12 months? Mechanical (1), Physiological (2), Multiple (3); age ≥70 or frail (2); mobility assist device (1) confusion or disorientation (5); impaired gait (1); incontinence (1); intoxicated (3); procedural sedation (3); and unconscious (5). All except for the last 3 variables were adapted from inpatient risk tools. Patients were categorized as low (1-2 points), moderate (3-4 points), or high risk (5+ points) and those scoring ≥3 had a safety protocol implemented. The survey regarding perceived knowledge for management of falls led to an average score of 86.6% (n=46). When tested on their actual knowledge they scored 48.8% (n=29). Following training on the FRM tool and protocol, the actual knowledge of 18 respondents averaged 83%. Conclusion: The FRM screening tool has been implemented and a comparative study looking at ED risk predictability matched to existing falls risk scores. Based on research findings the FRM will be considered for a provincial implementation.