Introduction
Falls cause serious problems for the ageing population, severely impacting quality-of-life and costing the NHS £2.3billion+ annually. Through our hospital-trust we noticed inconsistent assessment of patients’ post-falls, causing variable patient care. Our quality improvement project(QIP) assessed current quality of post-falls assessments and implemented strategies for improvement.

Aims
Evaluate junior doctors’ knowledge of assessing patients post-falls. Educate on correct protocol and the multifactorial-falls assessment as per NICE guidelines.

Methods
NICE Guidelines were reviewed to generate a questionnaire evaluating junior doctors’ knowledge. Specifically, looking for completion of eight of the multifactorial-falls assessments. Staff were surveyed for barriers. Questionnaire was sent to 40 junior doctors in each cycle. After analysing responses, implementations were undertaken through PDSA-cycles and performance re-audited.
Cycle 1: Teaching sessions educating junior doctors.
Cycle 2: Posters created to raise awareness.
Cycle 3(in progress): An easy-to-use post-falls proforma in patients’ notes.

Results
Initial questionnaire showed 82% of junior doctors were unsure what needed completion in a post-falls review. 63% unaware the Multifactorial-Falls Assessment existed, of the 37% aware only 9% performed the assessment. Post-intervention questionnaires showed increased knowledge of junior doctors after second cycle. Particularly, understanding need for GCS recording(73% to 100%), visual-assessment(27% to 56%), FRAX score(18% to 58%), gait-assessment(45% to 62%), lying-standing blood pressure(55% to 100%) and utilising NICE head injuries guidance(90% to 95%).

Conclusion
Generally, falls assessments are not performed well. Significant positive outcomes resulted from this QIP by promoting junior doctors’ knowledge. We hope introduction of a well-designed proforma in patients’ notes will lead to further improvements.

Authors:
Yasmin Divecha, Barking, Havering and Redbridge NHS Trust, United Kingdom
Shuchi Kohli, Barking, Havering and Redbridge NHS Trust, United Kingdom
Jiang An Lim, Barking, Havering and Redbridge NHS Trust, United Kingdom
Kiranjit Somal, Barking, Havering and Redbridge NHS Trust, United Kingdom

About the Presenter(s)
Dr Yasmin Divecha is a Foundation Year 2 Doctor, at Barking, Havering and Redbridge NHS Trust, UK.

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