Quality Improvement of Fall Prevention Among Elderly Patients in Medical Private Wards, Maharaj Nakhon Si Thammarat Hospital

Abstract

Background: Fall in hospitals are adverse events that result in patient injury, prolonged length of stay, and increased healthcare costs. Systematic surveillance based on 3P Safety standards is essential to ensure patient safety.

Objective: To improve the quality of fall prevention among elderly patients in the medical private ward of Maharaj Nakhon Si Thammarat Hospital.

Materials and Methods: This quality improvement project employed a nine-step Focus PDSA process. The participants consisted of 1) 25 registered nurses and 2) 171 elderly patients admitted between January and June 2025. Research instruments comprised: 1) the I’M²-SA²F²E fall risk assessment tool, 2) the CARE-ME fall prevention guideline, 3) a nurse satisfaction questionnaire, 4) a fall incident report form, and 5) focus group discussion questions. and (6) a fall incident record form. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed by content analysis.

Results: Implementation of the I’M²-SA²F²E risk assessment and the CARE-ME fall prevention guideline demonstrated positive outcomes. 1) Process outcomes: Showed a high feasibility of implementation (M=4.60, S.D.=0.40). 2) Outcome results: The fall incidence rate decreased to zero (zero event), and overall nurse satisfaction was also high (M=4.38, S.D.=0.32).

Conclusion: The quality improvement initiative resulted in the development of a clear fall risk assessment tool and a practical fall prevention guideline that enhanced nursing practice and patient safety. The standardized approach supports the safety dimension of quality. The developed guideline should be implemented in other wards.