Preparing patients at high risk of falls for discharge home after rehabilitation: Do we meet the guidelines?

Abstract

Aim: To determine whether rehabilitation inpatients at high risk of falls receive adequate falls risk assessment, management and handover on discharge as per Australian Best Practice Guidelines. Methods: Medical records of 121 people who received inpatient rehabilitation were retrospectively screened; records of 50 people discharged home and at high falls risk (fall in last 12 months, fall preceding/during admission) were audited. Data extracted included falls risk identification during rehabilitation and in discharge documentation; falls risk factors assessed; and fall prevention strategies implemented. Results: Discharge documentation correctly identified falls risk for just nine of the 50 people. Patients at high falls risk had a median of 8.0 (interquartile range 6–10) of 17 risk factors. There was limited evidence of assessment for osteoporosis (n = 8), footwear (n = 4) and visual assessment in the previous 2 years (n = 1). Patients received a median of 6.5 (interquartile range 5–9) out of 16 possible strategies. Common strategies were mobility (n = 48), strength (n = 44) and Personal Activity of Daily Living training (n = 43). For 12 risk factors, if the factor was present, there was evidence of a strategy in more than 80% of records. Conclusions: There was little evidence that people at high risk of falls received systematic falls risk assessment during rehabilitation. When a risk was identified, generally a strategy was implemented. However, failure to assess some risk factors might have limited fall prevention strategies offered. Failure to adequately address risks during hospitalization could contribute to falls post-discharge.