Poster Presentation at Forever Autumn COP Falls Conference Dublin 2015

1. KNOWLEDGE, ATTITUDES AND PRACTICES OF INTERNS
IN THE POST-FALL MANAGEMENT OF PATIENTS IN AN ACADEMIC TEACHING
HOSPITAL
Clifford, G.T.1, O’Shea, D.2
1.Clinical Specialist Physiotherapist. 2. Consultant Geriatrician.
Department of Elderly Medicine, St. Vincent’s University Hospital, Dublin 4
Background
‘Doctor, can you please come and review this
patient who fell?’ is a common request of intern
doctors. Recent NICE Guidelines (2015) require
older people who fall in hospital to have a medical
review (Statement 3). However, little is known on
the knowledge, attitudes and practices of interns
doctors in the immediate post-fall management of
patients.
The aim of this study is to explore the knowledge,
attitudes and practices of interns in the
management of patients in the immediate post-fall
period.
Methodology
A convenience sample of interns (n=16; 40%) were
selected to complete a written questionnaire
comprising the following constructs: injury
management, preventing further falls and improving
bone health. The questionnaire comprised polar,
Likert scale and open-ended questions.
Descriptive statistics were used.
Conclusion
Interns appear confident in their ability to identify
and manage injuries. An education programme on
the role of interns in preventing further falls and
improving bone health in the immediate post-fall
period should be developed and implemented.
Medical review of a patient in the immediate post-
fall period provides an opportunity to identify injury,
prevent further injury, prevent further falls and
improve bone health.
Correspondence: gareth.clifford@svuh.ie
Results
Injury Management: All interns believe their role is
‘very important’ or ‘important’ in identifying injury
post-fall. Nearly all interns report ‘always’ routinely
asking a standard patient history, performing a
standard clinical examination and considering red
flags for CT brain during their patient assessment.
1
1
1
1
8 2 2
0% 20% 40% 60% 80% 100%
Mech of Fall
Head Injury
Hip Trauma
LOC/Blackout
Previous Falls
Pain
Figure 1
When Taking a Patient History, Do You Routinely Ask
the Following?
Always
Most Times
Sometimes
Rarely
Never
2
4
5
2
2
7
8
7
4
2
4
1
0% 20% 40% 60% 80% 100%
Rationalise HFRM
Identify HFRM
Review Drug Record
Figure 2
In the Event of a Fall, Do You Routinely?
Always
Most Times
Sometimes
Rarely
Never
Improving Bone Health: Nearly 60% of interns
believe they have an important role in preventing a
future fracture. However, over 60% ‘rarely’ or
‘never’ consider bone health options, such as DXA,
anti-reabsorptives, or supplementation in the
immediate post-fall period.
Preventing Further Falls: A quarter of interns
believe they have ‘little importance’ in preventing
further falls. Interns report not reviewing the
patient’s medication record as standard practice,
nor identify or rationalise medications as
appropriate. Reasons given include: time
constraints, risk/benefit of the particular drug and
lack of knowledge. In fact, nearly 70% of Interns
could not name 5 or more high falls risk medication
classes (HFRM).
2 4 8 2
0% 20% 40% 60% 80% 100%
Do You Ever Consider Patients' Bone Health in the Immediate Post-
Fall Period?
Always
Most Times
Sometimes
Rarely
Never