Since the visit by the Ordre des infirmières and infirmiers du Québec [Quebec Order of Nurses] in 2010, the evaluation of the risk of falling by users has been carried out based on the Morse scale, a method recognized in several care areas. Using this scale, the nurses of the Marie-Clarac Hospital (MCH) found that the risk of falling was high for most users, resulting in a certain complacency about the risk. Furthermore, the analysis of prevalence indicated that 66% of users presented a high risk of falling. Indeed, such a high number of users presenting the risk of falling made personal preventive intervention difficult. The impression received by the health team was that the type of assistance was being left undefined, rather than tailored to each user’s needs. Furthermore, nurses’ expertise was not used to the full when evaluating the risk of falling. The nurses thought that they were being simply asked to complete a form, without adding any value to the process. Such dissatisfaction with user evaluation led us to rethink the process and implement some quality improvement measures in the fall of 2015. The objective of this program was to provide an effective evaluation tool for the assessment of the risk of falling, specific to physical rehabilitation. With this in mind, a task group was set up, consisting of experienced nurses, with considerable clinical insight, allowing them to identify the highest risk factors, specific to our clients. Significant risk factors identified included: incautious behavior (recklessness, impulsiveness), cognitive problems (dementia, delirium, senility, difficulty with implementing advice, altered judgment) as well as bowel and urinary urgency. Where one of these factors was combined with a mobility problem, the risk of falling was higher. The factors to be considered in an evaluation which is limited to set circumstances, such as history of falling incidents, reduced fitness or medication, must also be taken into account in the overall evaluation. When evaluating the risks, the nurse should use his/her clinical experience to identify the issue, bearing in mind the user’s individual circumstances. All risk factors identified were consistent with those quoted in available scientific writings. The tool was then adapted and re-validated by the members of the task group and the organization’s clinical experts, with the view to ensure that the criteria used to define the risk of falling are exact and understood. The role of clinical experts was entrusted to conseillères cliniciennes en soins infirmiers [clinical nursing care consultants] (CCSI) and conseillères en soins infirmiers [nursing care consultants] (CSI). A pilot program was launched in two care units, on November 11, 2015 and on January 20, 2016. The program, entitled “Evaluation of the risk of falling and HMC interventions”, consisted of evaluating the users with the new tool. Day, evening and night nurses were given clinical assistance to allow them to familiarize themselves with the tool, through regular quality audits. A prevalence assessment was then carried out by two clinical nursing care consultants, which indicated that 29% of the users were considered to present an increased risk of falling, which was consistent with the envisaged targets. Furthermore, an evaluation of the users who had already fallen was carried out, with the view to assessing the risk they presented before the fall. The results indicated that a high risk of falling had been identified in 94% of cases, before the fall actually happened. The quality of nurse’s evaluation was also assessed and it was found that 83% of evaluations were consistent with those made by clinical experts, which indicated that the tool was relatively easy to implement and use. Furthermore, this indicated that the nurses had all the data they needed to make an educated decision regarding the user’s risk of falling. Since January 2017, all health units offering rehabilitation services have been using the HMC evaluation tool to assess the risk of falling. A follow-up of the implementation of the tool has been conducted amongst nurses on a monthly basis, assuring continuity.
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