Authors (including presenting author) :
Ko SF(1), Tsoh J(1), Cheng PSP(1), Cheung HJ(1), Lee KL(1), Leung CY(1), Luk KH(1), Tsang PL(1), Wong SM(1), Yuk KL(2)(3), Lam SLS(4), Lee WYM(4), Lau M(5), Poon WKV(5), Chan CC(1), Li SYC(6)
Affiliation :
(1) Department of Psychiatry, (2) Quality and Safety Committee, (3) Department of Medicine and Geriatrics, (4) Department of Physiotherapy, (5) Department of Occupational Therapy, (6) Central Nursing Department, Shatin Hospital
Keyword 1: :
Multimodal Fall Prevention Program
Keyword 2: :
Acute Psychiatric Setting
Keyword 3: :
Sustaining Safety
Keyword 4: :
Rising Service Demands
Introduction :
Falls in psychiatric wards are significant adverse events leading to physical injury and prolonged hospitalization. This risk is increasingly compounded by demographic ageing and the complex interplay of psychotropic medications and behavioral agitation. In 2024, our unit observed an upward trend in fall rates. Clinical review identified increasing patient throughput and clinical complexity as key contributory factors to this heightened risk.
Objectives :
(1) To evaluate the efficacy of a newly formulated Multimodal Fall Prevention Program in a high-throughput psychiatric setting; (2) To demonstrate that clinical safety can be maintained amidst rising occupancy pressures through targeted, team-based intervention.
Methodology :
A multimodal fall prevention strategy was implemented between April and June 2025, structured via the 5M1E framework: 1. Man: Staff competency training; caregiver engagement 2. Machine: Injury-reduction airbag vests; assistive mobility devices (e.g., Sara Stedy) 3. Material: Visual bedhead risk identifiers; non-slip footwear 4. Method: Standardized admission orientation; structured clinical handovers; rigorous post-fall reviews 5. Measurement: Early orthostatic hypotension screening 6. Environment: Hazard scanning; designated observation zones. A quasi-experimental pre-post design compared monthly fall rates (falls per 1,000 bed-days) between Pre-Intervention (Jan 2024 - Mar 2025) and Post-Intervention (Jul - Dec 2025) periods using Welch’s t-test.
Result & Outcome :
During Pre-Implementation (15 months), the unit managed 45,228 bed-days with 12 falls, resulting in a mean rate of 2.68 (SD 3.32) falls per 1,000 bed-days. Service demand peaked during implementation (+4.2%). Post-Implementation (6 months) recorded 18,533 bed-days. The mean rate decreased to 0.51 (SD 1.24), representing a marked 81.1% reduction. Statistical analysis confirmed significance (p=0.042, Welch’s t-test). Notably, the unit achieved zero falls in 5 of 6 post-implementation months, indicating robust process stability. Despite this peak service demand, the intervention successfully minimized the fall rate to a consistently low level. Findings confirm the clinical applicability of this team-based multimodal 5M1E intervention to effectively mitigate fall risks and foster a resilient safety culture, while maintaining care quality despite resource constraints, demonstrating potential for boarder clinical adoption.
