For many Australian hospitals, April is ‘No Falls Month’. This month we have a full-scale education attack against one of the most prevalent forms of in hospital patient harm – the fall. In the consistent form of Injectable Orange we have a not so hidden curriculum – critical appraisal and evidence based practice. There is a wealth of information relating to best practice in preventing falls and harm from falls, however there is little to guide the accurate prediction of future falls for geriatric patients presenting to the Emergency Department. This is of importance, because not every person presenting with a fall is admitted to hospital and as such, the potential to reliable screen and intervene or refer to supporting services is a primary and preventative health priority.

As part of our education this month, I would encourage the enthusiastic ED nurse to read the following article. While reading the article, take the next step and cast a critical eye at the quality of the systematic review. Here is the CASP tool to help with this appraisal. Once you have formed your own opinion have a listen to the podcast below. We’d love to hear your thoughts and also any great initiatives you are using to help prevent falls and harm from falls in your ED or wards, leave a comment below!

Remember this all counts toward your nursing continuing professional development. Pro-tip on organising and capturing your CPD activities: keep a portfolio. Quite simply, document your intended personal learning objective; identify a high quality resource that addresses this (article, workshop, conference); document a reflection on your achieved personal learning outcome. For a comprehensive overview of a Nursing Professional Portfolio head to this guide from the ACN. My newly discovered resource for keeping track of CPD portfolio is this great app from Ausmed Education.

The Article

Carpenter, C. R., Avidan, M. S., Wildes, T., Stark, S., Fowler, S. A., & Lo, A. X. (2014). Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 21(10), 1069–1082. http://doi.org/10.1111/acem.12488

The Podcast

For the uninitiated, The Skeptics’ Guide to Emergency Medicine (The SGEM) is a weekly podcast hosted by the brilliant Dr Ken Milne, Canadian Emergency and Family Medicine Physician. Ken pitches a clinical case and then reviews a recent or ‘Hot of the Press’ article that may potentially answer the question. Ken will invite a guest skeptic to help appraise the ‘game changer’ quality of the article and for select episodes will discuss with a principal author of the publication. The SGEM uses the Best Evidence in Emergency Medicine (BEEM) appraisal tools to form the structure of the conversation and also to subversively teach us a reliable and reproducible format for our own critical appraisal.

In this episode Ken discusses the above article with it’s primary Author Dr Chris Carpenter addressing the following case and question.

Case: 84yo woman (Mrs. C) who lives independently and alone in her own home presents to the emergency department via ambulance with a standing level fall. She was bending over to pick up a letter that had dropped off her desk, lost her balance and hurt her left, non-dominant arm. After the fall she was afraid to stand and could not reach her telephone so she laid on the floor calling for help until a neighbor heard her and called 911. She notes infrequent falls at home with no prior injurious falls. Her past medical history includes hypertension and a remote history of breast cancer, but she does not take anti-platelet or anticoagulant medications. An appropriate physical exam is performed and reveals an isolated left shoulder injury. The x-ray of her left shoulder is negative for any fracture. She is diagnosed with a minor contusion and provided with some acetaminophen. The daughter-in law arrives to take her home, but asks if Mrs. C is at risk for further falls in the future.

Question: Can healthcare personnel accurately identify subsets of geriatric adults at increased risk of falls or injurious falls in the months following an episode of emergency department care?

SGEM#89: Preventing Falling to Pieces