421 – Full Cycle Audit of the Quality of Fall Reviews by Junior Doctors in Oxford Deanery

Abstract

Background:

Elderly psychiatric patients are at constant risk of having a fall due to numerous reasons e.g. frailty, gait problem, vision problem, cognitive and judgment impairment, psychotropic medications.

Consequences of a fall for an elderly patient could be potentially life threatening, protracted, painful and detrimental. Also the cost of falls for NHS is enormous.

Objective:

To improve the quality of fall reviews undertaken by junior doctors in Oxford Health Foundation Trust.

Methods:

The quality of a random sample of 23 fall reviews by junior doctors was assessed against the national guideline (NICE guideline No.: CG21).

Proper actions taken to raise the awareness of junior doctors i.e. circulating an email and short talk about national standards.

The second cycle (Sample size: 17) in 6 months time showed substantial improvement in most areas but not all of them.

In the next stage a “Fall intervention proforma” designed for the wards. Also reminding posters were mounted in clinical rooms and junior doctors’ offices.

The third cycle (Sample size: 10) in 6 months time conducted to assess the sustainability of improvements in our compliance.

Results:

Our compliance improved from less than 50% in most essential components of a high quality fall review (Musculoskeletal examination, Neurological examination, History taking, Cardiovascular examination, Medication review) to around 100% in 3rd cycle.

Recommendations:

• – routine use of “Fall intervention proforma” as standard check list on the wards

• – mounting of reminding posters in clinical rooms

• – a short talk about fall reviews in induction programme for new junior doctors