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Maine Medical Center/P6



Samantha Beckwith, BSN, RN, PMH-BC, P6

Background: The Inpatient Psychiatry unit at Maine Medical Center (P6) is a 21-bed unit specializing in geriatric and medical psychiatry. The majority of patients have a primary diagnosis of Dementia with Behavioral Disturbance. The unit features 12 double occupancy rooms and one single occupancy room, as well as a large activity room. Patients participate in a therapeutic milieu in which they are encouraged to interact with other patients in common areas and ambulate around the unit. The average number of patients is 19.6 with an average length of stay of 27.2 days (FY 2020). The targeted nurse to patient ratio is 1:5.3 for days and evening shift (0700-2300) and 1:8 for night shift (2300-0700).

On admission to P6 each patient receives a comprehensive interdisciplinary fall risk assessment including completion of the New York Presbyterian Fall/Injury Risk Assessment Tool by nursing (this is also completed once a shift and following a fall), and the Bedside Mobility Assessment Tool (BMAT) by nursing. Occupational Therapy (OT) assessed fall risk via the ‘Get Up and Go’ Fall Risk Assessment. Every patient’s fall risk level is discussed each morning in our interdisciplinary treatment team meeting. Based on nursing assessments, nurses deploy fall risk interventions based on the MMC Policy “Fall Risk Identification and Management”. Interventions may include inclusion in the “Yellow Shirt Program” for patients found to be a ‘Very High Fall Risk’ based on the interdisciplinary fall risk assessment. They are placed in a yellow shirt or “Johnny” which provides a visual cue to all members of the treatment team that the patient should not be ambulating alone.

Purpose: The purpose of this project was to search and review the current literature for interventions to prevent falls in geriatric psychiatry patients. The aim was to answer a question: In geriatric psychiatry patients, are there specific fall interventions that decrease fall rates that P6 is not currently utilizing?

Evaluation of Current Research/Literature: A literature search was performed. Databases used were CINAHL and PubMed. MMC librarians also completed the search and provided articles. Key terms used were falls, geriatric, psychiatry, psychiatric, geripsych, fall interventions, psychotropic medications and associated side effects, ataxia, extra pyramidal symptoms, orthostatic hypotension, blood pressure changes, psychomotor slowing, sedation, altered mental status, behavioral disturbances, cognitive impairments, encouragement of activity, history of falls, physical deconditioning, poor safety awareness. Fifteen articles were found and nine were included in closer evaluation.

Key Issues: In the evaluated literature, the estimated fall rates in acute care hospitals ranged from 1.3 to 8.9 per 1000 patient days (Greely et al., 2020). On geriatric psychiatry units, fall rates have been reported to be as high as 13.66 per 1000 patient days (Struble-Fitzsimmons et al., 2019). This rate is noteworthy because falls are the leading cause of injury related deaths among people aged ≥65 years (Quigly et al., 2014). Serious fall related injuries result in increased length of stay, loss of function, loss of life, and financial burden (Khurshid & Lantz, 2016). Odds of fall related injury among patients with cognitive disorders such as Alzheimer's disease and other dementias were found to be at least 3 times greater than those among the general elderly population (Quigley et al., 2014). As the mobility of geriatric psychiatry patients deteriorates, so does their ability to recognize, judge, and avoid hazards (Neyens et al., 2009).

Results/Implications for practice: Eighteen interventions were found to be supported by the literature; P6 is utilizing 16 of these interventions. The two interventions not currently utilized on P6 are hip protectors and floor mats. The feasibility and costs to implement these interventions will be explored in the future. Evaluation of the literature helped to identify falls preventions with supporting evidence that have been not used before in our unit/P6.