SINGAPORE — In 2010, Ren Ci Community Hospital found themselves with a problem on their hands: When left unattended, some of its elderly patients would sustain falls when they tried to move around on their own, sometimes injuring themselves badly.

The hospital promptly set about addressing the problem but, unexpectedly, the solution did not involve expensive camera surveillance systems or sophisticated bed alarms.

Instead, with only S$15 worth of badges for its staff and a change in how staff communicated on looking out for the patients, the hospital reduced the number of falls leading to serious injuries from six reported cases in 2010 to zero last year.

The effort won the hospital a Special Mention Award at this year’s Singapore Health Quality Service Award, organised by SingHealth.

IDENTIFYING THE CAUSE

Ren Ci’s fall rate in 2010 was 1.12 per cent, compared to the “baseline” fall rate of 0.6-0.7 per cent set by the Ministry of Health (MOH) for hospitals.

Alarmed, the hospital’s Clinical Quality Management Unit (CQMU), which looks at how to improve services and patient well-being, put together a Fall Prevention Team.

The team found that more than 80 per cent of the falls were unwitnessed, and happened when the nurses on duty went on breaks or left to perform other tasks, without ensuring that another nurse took over their watch, said team leader Min Min Aung, a Quality Executive in the CQMU. A shortage in staff, at that time, added to the problem, he added.

A solution was needed, but the hospital had a few considerations.

“As a voluntary welfare organisation, having limited resources meant that we cannot afford camera surveillance or bed alarms, so we had to brainstorm to use what we already had,” Mr Min said.

S$15 AND A REBOOT OF PROCEDURES

Realising that unattended patients typically fell when they were unable to reach a nurse and tried to get out of bed or from their geriatric chairs themselves, the hospital moved to ensure each patient has a call bell whether they are in bed or on their chair.

To ensure nurses did not leave their posts before another nurse arrived to take over, the hospital began handing out Fall Champion badges in 2011. With this initiative, nurses on duty would have to pass the badge on to the next nurse before they left their stations.

These badges were inspired by a similar initiative in a Hong Kong hospital, which Ren Ci’s then-Nursing Director Mak Ngai Khan saw on a visit.

Signs were also put up to remind staff not to leave patients unattended.

Staff nurse Isabelita Sumalinog, 37, said: “The badges help a lot — knowing that there is at least one person constantly watching the patients, we can go on our breaks without worrying if anything would happen.”

The hospital also went beyond the MOH guidelines on long-term care to improve its fall risk assessment process for patients, by adding additional guidelines from the Australian system.

“Previously, fall risk assessment data collated by doctors would be filed directly into the IT system and no one else would know whether a patient was at a high, moderate or low fall risk, nor was there a guideline of intervention methods,” said Mr Min.

A new fall risk assessment document ranking the patient’s risk level was created, and unlike before, the document must be acknowledged by nurses to ensure they are aware of the patients’ risk levels.

These efforts, among others, have helped bring Ren Ci’s patient fall rate to 0.57 per cent.

Mr Min said the research and implementation of all the initiatives took a year, adding that a new batch of nurses in 2011 also helped alleviate the situation.

Noting that 62 per cent of the patients who fell had cognitive impairment — such as dementia — and had difficulty understanding or obeying nurses’ instructions, the hospital plans to implement a new set of measures in June to address this.

Such patients may be identified with tags on their clothes so that nurses can take extra care of them, and their beds may be placed directly in front of the each nurse’s station. The beds will also be placed against a wall to minimise chances of falling off the bed.