The Person-Centred Fall Risk Assessment Tool (PHFRAT) is designed to assess and mitigate fall risks in aged care settings. This article analyzes data from PHFRAT assessments in Residential Aged Care Facilities (RACFs), examining its practical application and identifying areas for improvement. We’ll delve into the assessment process, common fall risk factors, prevalent interventions, and insights from healthcare professionals.
PHFRAT Implementation in Practice
A study involving 215 residents and 703 PHFRAT assessments in RACFs revealed key demographics and fall risk prevalence. Two-thirds of the residents were female, aged 85 or older, and born in Australia. Over half had a history of falls. Dementia, depression, and anxiety were prevalent diagnoses.
PHFRAT Workflow in Residential Aged Care
The PHFRAT assessment process, typically conducted by registered nurses (RNs), is divided into three parts: initial risk stratification, identification of specific risk factors, and documentation of fall prevention interventions. Nearly half of the assessments were completed within a month of admission. Based on Part 1, residents were categorized into low (26%), medium (40%), and high (34%) fall risk categories. Part 2 revealed that the most common risk factors included recent falls, mobility issues, and behavioral problems. The average number of risk factors identified per assessment was 4.6, increasing with the assigned risk level.
Part 3 focused on documenting interventions, with an average of 3.8 interventions per assessment. While 88% of assessments documented interventions, only 22% included a scheduled review date. Alarmingly, 70% of residents experienced a fall before their scheduled review, prompting a reassessment.
Common Fall Interventions and Their Effectiveness
Fall interventions documented in the PHFRAT were categorized into ten broad groups, primarily focusing on device provision (e.g., mobility aids, fall prevention devices) and staff assistance (e.g., direct help, close supervision). Direct staff assistance and close supervision were the most frequently documented interventions. However, there was little variation in the types of interventions prescribed across different risk levels, suggesting a lack of sensitivity to individual needs.
ADPIE-C Coding Strategy for Qualitative Analysis
Qualitative Insights from Healthcare Professionals
Interviews with healthcare professionals, including RNs, care managers, and physiotherapists, provided valuable insights into PHFRAT’s practical use and limitations. While generally perceived as a holistic tool, concerns were raised regarding incomplete documentation, inconsistent communication of findings, and a lack of tailored interventions based on individual risk levels. Staffing shortages, inadequate training, and limitations of the clinical management system were cited as contributing factors to these challenges.
Improving PHFRAT Implementation and Effectiveness
Several recommendations emerged for enhancing the PHFRAT’s effectiveness: improved staff training, mandatory fields within the IT system, greater multidisciplinary involvement, and clearer communication protocols. Participants emphasized that fall prevention is a shared responsibility requiring a coordinated and personalized approach. A standardized checklist of interventions and a more robust system for tracking and communicating assessment findings could significantly improve outcomes. The findings underscore the need for continuous evaluation and refinement of the Aged Care Risk Assessment Tool to ensure its effectiveness in preventing falls and promoting resident safety.
