Authors: (including presenting author): :
NG YSE(1), LI MN(1)(6), CHIU PL(1), CHI CY(2), WONG YY(3), SO SS(4), CHUNG CM(5), KWOK YT (6)(7), CHUI HY(6)(7), CHAN NH(6), LEUNG PMQ(1)
Affiliation: :
(1) Nursing Services Division, New Territories West Cluster (2) Department of Medicine & Geriatrics (Acute), Tuen Mun Hospital (3) Department of Medicine & Geriatrics (Rehab), Tuen Mun Hospital (4) Department of Orthopaedics and Traumatology, Tuen Mun Hospital (5) Department of Surgery, Tuen Mun Hospital (6) Fall and Restraint Committee, NTWC (7) Quality & Safety Division, New Territories West Cluster
Keyword 1: :
Fall Prevention
Keyword 2: :
Multicomponent Strategy
Keyword 3: :
Hospital Safety
Keyword 4: :
Patient Care
Keyword 5: :
Risk Assessment
Keyword 6: :
Healthcare Quality
Introduction: :
In 2024, there was a significant increase in the fall rate at Tuen Mun Hospital (TMH), with figures escalating from 0.43 in 2Q to 0.51 in 3Q. To address this alarming trend, multicomponent fall prevention strategies were developed and put into effect to reduce fall rate and enhance fall prevention measures.
Objectives: :
The primary aim was to decrease the occurrence of fall incidents within the in-patient setting. Through the implementation of multicomponent fall prevention strategies, the goal was to enhance nurse’s competency and accuracy in fall assessment, enabling them to implement tailored fall prevention measures based on individual patient needs and identified risks.
Methodology: :
In November 2024, a fall prevention taskforce was established, comprising representatives from the Nursing Services Division (NSD), M&G, O&T, and SURG. It aims to increase the awareness for fall prevention and streamline related measures. In addition to the universal prevention measures, enhanced strategies were adopted such as hourly patrolling by designated staff for high fall risk patients with documentation, implementation of a fall alert map system to enhance communication, and use of fall alarm mat system. Furthermore, NSD & Cluster Falls and restraint management committee revised the fall risk assessment form, incorporating examples to guide clinical judgment and outline specific interventions for patients at risk of falling. Following any fall incident, a joint visit involving representatives from NSD, Q&S and the department was conducted to review the fall assessment, discuss and identify root causes, and implement improvement measures. Addressing a specific root cause of patients escaping from ‘oversized’ safety vest due to a lack of appropriate sizes. NTWC introduced new safety vest sizes in July 2025 to ensure proper fit for all patients. By fostering two-way, open communication, staff could raise concerns freely and actively participate in fall prevention. Progress is monitored through regular review meetings held by the Fall and Restraint Management Committee, which also evaluates the effectiveness of preventive measures.
Result & Outcome: :
Total fall incidents and fall rate per 1000 IPBDO dropped from 459 in 2024 to 335 in 2025 and 0.32 in 2024 to 0.23 in 2025 respectively (decreased 27%), a downward trend was observed. The proportion of severe falls (Severity Index 3–6) also declined from 9.4% in 2024 to 8% in 2025 (decreased 15% decrease). The program has effectively reduced preventable harm, strengthened safety culture, and will continue with sustained monitoring and refinement to maintain and build on these positive outcomes.
