Evaluation of an emergency department Falls Pathway for older people: A patient chart review

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dc.contributor.authorO'Keeffe, Anne
dc.contributor.authorO'Grady, Sile
dc.contributor.authorCronin, Finola
dc.contributor.authorDolan, Clodagh
dc.contributor.authorO'Hea, Ann
dc.contributor.authorO'Shea, Katie Louise
dc.contributor.authorNaughton, Corina
dc.date.accessioned2020-07-02T11:13:48Z
dc.date.available2020-07-02T11:13:48Z
dc.date.issued2020-04-27
dc.date.updated2020-07-02T11:03:34Z
dc.description.abstractThe number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. Aim: This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. Methods: The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. Results: The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. Conclusion: The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid100869en
dc.identifier.citationO'Keeffe, A., O'Grady, S., Cronin, F., Dolan, C., O'Hea, A., O'Shea, K. L. and Naughton, C. (2020) 'Evaluation of an emergency department Falls Pathway for older people: A patient chart review', International Emergency Nursing. doi: 10.1016/j.ienj.2020.100869en
dc.identifier.doi10.1016/j.ienj.2020.100869en
dc.identifier.eissn1878-013X
dc.identifier.issn1755-599X
dc.identifier.journaltitleInternational Emergency Nursingen
dc.identifier.urihttps://hdl.handle.net/10468/10197
dc.language.isoenen
dc.publisherElsevier Ltd.en
dc.rights© 2020, Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.en
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectFalls Pathwayen
dc.subjectFalls risk assessmenten
dc.subjectEDen
dc.subjectRisk reductionen
dc.subjectCommunity falls servicesen
dc.subjectEmergency departmenten
dc.titleEvaluation of an emergency department Falls Pathway for older people: A patient chart reviewen
dc.typeArticle (peer-reviewed)en
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