Category: Scheme best illustrating Technological Innovation
Name: Dr Opinder Sahota
Job Title: Consultant Physician
Organisation: Queen’s Medical Centre, University Hospital NHS Trust
Email: opinder.sahota@mail.qmcuh-tr.trent.nhs.uk
Telephone: 0115 9249924 36197
Key team: Opinder Sahota, Tony Till, Jenny Parberry, Jane Piper, Matthew Grainge
Title: Reducing hospital in-patient falls using bed and bedside chair pressure sensors
Falls are common among hospital in-patients. In 2003, there were 2759 reported events at the QMC. Patients suffer both physical and psychological injury, which in turn leads to impaired rehabilitation and co-morbidity. The cost to the NHS is enormous both to the staff : anxiety and guilt and financially : extended lengths of stay, higher rates of institutionalisation and the potential of litigation.
We know that many hospital patients recovering from acute illness may go through a period of transient risk and that others with chronic gait instability and cognitive impairment may be at risk of falling throughout admission.
We hoped to develop an intervention to reduce in-patient falls.
Patient benefits:
- Reducing falls and subsequent injury
- Preventing unnecessary extended length of stay
- Avoid deterioration in well being by preventing falls
- Hospital benefits:
- Preventing anxiety/guilt amongst staff by preventing in-patient falls
- Reducing mean length of stay
- Avoiding potential litigation
60% of in-patient falls occur at the patient’s bedside either whilst getting off the bed or bedside chair. In the majority of cases these are unwitnessed and where patients are advised to call for assistance there is often a reluctance (don’t want to bother the nurses) or an inability (cognitive impairment).
Thus a reduction in in-patient falls was achieved using a bed and bedside chair pressure sensor, incorporating a radio pager, attended to by the ward auxiliary nurses.
The sensors comprise of two pressure plates, one, which sits under the patient’s mattress, and one, which sits under the patient’s chair. These are connected to a transformer which is simply a small box attached to the back of the bed, running on a 9v battery. Pressure changes are identified as the patient leaves the bed or chair, which alerts a member of staff via a radio pager. The pager can link up to 16 beds. The system also comes with an audible alarm mode, which can be set to ‘on’ during the day.
A collaboration was made between the manufacturer of the pressure sensors and ourselves (consultant and ward B2 staff).
The system was evaluated over an 8-month period on the orthogeriatric rehabilitation ward B2, QMC. This is an 18-bedded unit taking elderly female patients post acute hip fracture. Rate of bedside ‘fallers’ and length of stay were compared to the previous year. The mean percentage of in-patient bedside ‘fallers’ prior the sensor was 9.5% (20/210). Using the sensors this was reduced to 5.2% (8/153) [OR 0.46 (95%CI 0.2,1.1)], relative risk reduction 54%, adjusting for age and length of stay. Mean difference in length of stay between ‘fallers’ and ‘non fallers’ was 9.8 days (95%).
Initially we approached a local electronics firm to adapt a pre-existing sensor. They requested £1500. The Health and Safety Board, QMC agreed to fund £500 but the Clinical Governance Board, QMC, although recognised the work as worthy was unable to offer any support.
We then approached Sensorcare Ltd offering them evaluation of their equipment in an NHS setting in return for a free loan of the equipment.
Having established the link with Sensorcare Ltd, we then approached the Trust’s NSF Steering Group for Older People for support with data collection. This was declined due to insufficient resources.
Data collection, analysis and writing up was therefore undertaken by members of the group in their own time.
Unexpected benefits:
- Increased job satisfaction reported by the auxiliary nurses who overall felt
- more valued given their role in carrying the radio-pager devices and actually
- being involved in preventing the falls.
- Patients themselves felt reassured that although advised to call for assistance when trying to leave the bed, often forgot but were reassured when nearly falling ‘a nurse turned up’. One patient commented that it felt like ‘big brother was watching you’.
- Relatives informed of the project felt very reassured for their family members and welcomed the unique innovation.
- Recognition by the Trust’s leadership and examples or good practice team
The next steps are to:
- Continue to evaluate the system for another 4 months
- Undertake a more formal cost-effective analysis
- Applied to the Health Technology Assessment, DoH for a more formal randomised controlled trial.
Many departments and organisations have visited the ward to share our experience. Various care home settings are now using these systems and we are aware of two Trusts who have invested in this system.
We intend to share the good news by presentations at both regional and national meetings (abstracts already submitted to the British Geriatrics UK meeting and the National Osteoporosis UK meeting and more recently a formal invitation to present the work at the Trent Regional Falls meeting).
