Prevention of falls and harm from falls at SMHS

South Metropolitan Health Service (SMHS) promotes a culture of zero harm, including zero harm from falls.

About falls

An older woman completes some paperwork. An older man sits next to her, with a walking frame in front of him.Each year nearly one quarter of people over 60 years of age will experience a fall. For some people, the injuries caused by their fall may be so serious that they can no longer live independently.

Falls account for over 80 per cent of all injury-related hospital admissions for people aged 65 years and older. They can occur at any age, but the frequency and severity of falls-related injuries increases significantly with age and frailty.

Falls are one of the most frequently reported clinical incidents in hospitals worldwide and are associated with increased:

  • length of hospital stay
  • care and use of health resources
  • discharge rates to a nursing home or residential care facility.
Measuring falls

The World Health Organization (WHO) defines a fall as an event which results in a person coming to rest accidentally on the ground, floor or other lower level. This definition covers all types of falls-related clinical incidents, including:

  • near-misses
  • intercepted falls where the patient is lowered to the ground
  • suspected/unwitnessed slips/trips/falls
  • witnessed slips/trips/falls.

Falls are measured as a rate of falls using the number of falls-related clinical incidents divided by the number of beds occupied by patients each day (occupied bed days).

Benchmark rates

Fall rates of 4–12 per 1,000 bed days during healthcare have been described in patients 65 years and older.

In certain hospital settings, such as rehabilitation, more than 40 per cent of patients with specific clinical problems experience 1 or more falls during their admission. Of these falls, 30 per cent result in injuries.

SMHS promotes a safety culture of zero harm, including zero harm from falls. 

As there is currently no national or state agreed falls rate benchmark, SMHS sites and services use the Australian Council for Healthcare Standards (ACHS) annual peer rate as the benchmark. The ACHS annual peer rate provides a comparison based on a yearly average across all Australia/New Zealand organisations participating in the ACHS Clinical Indicator Program. The most recently published ACHS annual peer rate is for 2015 and equates to ≤3.5 falls per 1,000 occupied bed days.

To prevent falls and to work towards zero harm from falls, SMHS patients are assessed for the risk of a fall and the potential to be harmed from falls:

  • on presentation to hospital
  • during their admission
  • when clinically indicated.

A combination of falls prevention and harm minimisation strategies are then used for those patients assessed as at risk of falling. These strategies form a falls prevention plan for the patient, and this is monitored regularly to ensure its effectiveness and appropriateness.

Patients and carers are also informed of the identified risks from falls and are encouraged to participate in the development of their falls prevention plan. Read more information about falls prevention (Healthy WA).

When a SMHS hospital’s falls rate does not meet the agreed benchmark a review is undertaken and an action plan is developed to address the issue/s.  

See how we measure up

The graph below shows the overall falls rate across SMHS and the falls rate for each of the SMHS hospitals:

  • FHHS – Fremantle Hospital and Health Service
  • FSH – Fiona Stanley Hospital
  • RkPG – Rockingham Peel Group
  • PHC – Peel Health Campus

Coloured lines and numbers are used to display data.  When comparing data it is important to exercise caution, as hospital activity varies between sites.

Table: Quarterly falls rate per 1,000 occupied bed days in SMHS hospitals, April–June 2017

SMHS has averaged 2.64 falls per 1,000 occupied bed days from April 2016 to June 2017 which is below the SMHS benchmark rate of ≤3.5 falls per 1,000 occupied bed days. Fiona Stanley Hospital, Fremantle Hospital and Health Service,  Rockingham Peel Group and Peel Health Campus were all below the SMHS benchmark for patient falls April-June 2017.

What do these figures show?
  • The overall falls rate for SMHS has averaged 2.64 falls per 1,000 occupied bed days from April 2016 to June 2017. This is below the benchmark rate of ≤3.5 falls per 1,000 occupied bed days.
  • Fremantle Hospital and Health Service’s falls rate has reduced from 4.13 to 2.95 falls per 1,000 occupied bed days from Oct-Dec 2016 to Apr–Jun 2017. This is below the benchmark rate.
  • The falls rate for Fiona Stanley Hospital has remained below the benchmark at an average of 2.26 falls per 1,000 occupied bed days from April 2016–June 2017.
  • Rockingham Peel Group’s falls rate ranged from 3.33 to 2.50 falls per 1,000 occupied bed days between Apr-Dec2016. The falls rate increased to 3.68 in Jan–Mar 2017 and then reduced to below the benchmark at 3.25 falls per 1,000 occupied bed days in Apr–June 2017.
  • The falls rate for Peel Health Campus increased from 3.36 to 4.0 falls per 1,000 occupied bed days between Apr–Jun 2016 and Jul–Sep 2016. Since that time, however, it has decreased to below the benchmark and currently sits at 2.14 falls per 1,000 occupied bed days in Apr–Jun 2017.
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South Metropolitan Health Service