title: Risk-factor assessment for falls: from a written checklist to the penless clinic.
abstract: OBJECTIVE
  to audit risk-factor identification of fallers before and after an education programme and the insertion of a written checklist in medical notes. Risk-factor identification in a dedicated, computerized falls clinic was then examined.
  
  
  METHODS
  documentation of risk factors for falls was studied on wards and a self-auditing 'penless' clinic for fallers subsequently set up to generate reports for medical notes and letters for general practitioners.
  
  
  RESULTS
  risk-factor identification improved after the insertion of the checklist but remained relatively poor. A dedicated clinic allowed almost complete identification of risk factors. Of the first 112 patients (median age 82) seen in the clinic, 75 (67%) were housebound. Remediable risk factors--e.g. inappropriate medication (67%), unsatisfactory footwear (59%) and postural hypotension (17%)--were found in most. Thirty-three patients (29%) had difficulty with alarm raising.
  
  
  CONCLUSIONS
  ward-based intervention showed limited capacity to identify risk factors for falls: a dedicated clinic was more successful. The use of a portable computer with a programme to screen fallers for risk factors is worthy of consideration.
authors.affiliation: Academic Department of Geriatric Medicine, University of Birmingham, The Hayward Building, Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD, UK. c.a.dyer@bham.ac.uk
authors.forename: C A
authors.initials: CA
authors.lastname: Dyer
authors.forename: C L
authors.initials: CL
authors.lastname: Watkins
authors.forename: C
authors.initials: C
authors.lastname: Gould
authors.forename: J
authors.initials: J
authors.lastname: Rowe
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation / Q000379:methods; D004739:England; D005260:Female; D016330:Frail Elderly; D006751:Hospital Information Systems; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000009:adverse effects; D012307:Risk Factors; D012308:Risk Management / Q000458:organization & administration*; D012984:Software