factors. Using measures that restrict freedom instead of providing
proper care and implementing evidence-based fall prophylaxis is
reprehensible from both a human rights and an economic perspective.
When being admitted to hospital, all patients should be observed and
questioned with regard to fall risk factors. Then it should be decided
whether they are at risk for falls. Additionally, there should be analyses
in each ward with regard to frequent reasons for falls in order to
minimise risks inherent in the environment (damp or slippery floors, poor
lighting, lack of grab bars, high steps, etc.). Also situational
circumstances, such as the staff structure of a department, can affect
the risk of falls. In an individual case – best done by a multi-professional
team – measures must be planned and developed, information
distributed and, if applicable, therapeutic interventions implemented. It
has been proven that orientation training, exercises, investing in lowprofile beds, bed, chair and floor mat alarms, individually adjusted hip
protectors, visual aids, grab bars in hallways, etc. contribute to the
prevention of falls. Possible consequences of falls, such as hip fractures,
traumatic head and brain injuries and immobility, cause suffering.
From the perspective of the NPM, it can be expected that a systematic
fall prophylaxis in all hospitals and medical facilities would result in a
reduction of measures that restrict freedom. As is the case with most
Western countries, Austria is in the midst of a demographic change. The
over-80 segment of the population is increasing most significantly.
According to estimates, by 2040 there will be a million persons over 80.
Hospitals and medical facilities must begin to prepare themselves now.
In the NPM Report 2013 (pp. 38 et seq.), it was set out that the NPM
urges that a recommendation by the CPT to set up a central register to
record measures that restrict freedom be implemented in all psychiatric
medical facilities and wards in order to be able to evaluate their use and
frequency without consulting patient records.
The commissions found that despite discussions with experts initiated
by Gesundheit Österreich GmbH (national research and planning
institute for health care, GÖG) and the Federal Ministry of Health, such
registers are not yet available in most psychiatric medical facilities.
Solely the University Clinic for Psychiatry of the Regional Hospital in Graz
had an IT-supported central register that recorded all measures to
restrict freedom (as confirmed by Commission 3), which should be
positively highlighted. In July 2014, the Tyrolean hospital operating
company TILAK (TILAK = Tiroler Landeskrankenanstalten GmbH)
provided Commission 1 with a concept to set up such a register for the
first time. Plans in this direction were held out to Commission 4 by the
Baumgartner Höhe Social Medicine Centre and the Otto Wagner
Hospital and Care Centre. The NPM will continue to push for a seamless
set-up of such registers.
41
Central register to
record measures that
restrict freedom
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