Risks, roles and responsibilities: Evaluating falls in inpatient mental healthcare settings for older people

Abstract

Background Despite the large number of falls in mental health settings, we know little about what contributes to falls. The main aim of the study is to explore how fall risk, prevention and management is understood and experienced in everyday practice by patients, family carers and staff, in inpatient mental health settings providing care for older people. We looked at fall incident reports to determine where and when falls happened. We used observation, interview and focus group methods to help us explore experiences of falls from patients, family carer, staff and managers perspectives in 5 wards in one NHS Trust.

Findings Of patients experiencing a fall, almost half had a mental health problem other than dementia. We found most falls were in bedrooms (42%), and only 27% were directly observed by staff. Fall patterns were influenced by ward routines. Both staff and patients thought cramped/cluttered spaces had an impact on falls. We tracked 24 patients following a fall, all had a mix of mental and physical health problems which staff found challenging. Patients took between 4 and 12 medicines, including at least one associated with increased risk of falls. Staff considered falls to be a physical health problem and prevention the domain of physiotherapy/medical care. The main way staff prevented falls was through observing patients with little evidence of fall prevention education for patients. Some patients felt they lost physical function during their hospital stay. Staff found balancing patient independence and risk of falling challenging. Much thinking about risk management in relation to falls is undocumented. For senior managers, falls were one of a number of concerns relating to patient safety.

Conclusions Fall reporting is generally poor and falls underreported. Understanding the patterns of falls could help in planning care and staffing levels in order to reduce falls, but is specific to each setting. Nursing staff report that their specialist education is inadequate to support them to provide optimal care for this changing patient group. Education needs to keep pace with changing patient needs. There is a feeling among staff of a poor fit between what they do every day and fall policy/assessment tools. Staff require support to incorporate evidence-based practice and policy into practice. Staff have to balance the risk of falls due to patient’s fluctuating mental health condition and physical health with maintaining function and independence.