An Audit Of Fall Risk Screening, Using The 3 Key Questions, In Physiotherapy Initial Assessment Documentation In Primary Care

Abstract Background Falls and fall-related injuries are the most common reportable incident in the HSE. The World Guidelines for Falls Prevention (Montero-Odasso et al 2022) highlight the importance of opportunistic case finding. They recommend that clinicians ask all older adults the 3 Key Questions (3KQ) annually. The questions are: 1: “Have you fallen in the past 12 months”, 2: “Do you feel unsteady when standing or walking?” and 3: “Do you worry about falling”. Tools, like the 3KQ, that assess multiple fall risk factors are more sensitive at predicting risk. This helps identify more older adults at intermediate or high risk of falls with a goal of primary/secondary prevention of falls. The aim of this audit was to evaluate the inclusion and documentation of opportunistic case finding using the 3KQ in initial physiotherapy assessments for adults 65 years and over. Methods Physiotherapy initial assessment documentation for patients 65 years and over across 6 Primary Care teams were audited. The standard was opportunistic case finding as per the World Guidelines for Falls Prevention. The criterion was: All adults 65 years and older should be asked the 3KQ. If they answer yes to any of the questions, they should be assessed for falls risk severity and referred for tailored interventions. Results 60 charts were audited. There was 70% compliance for Question 1, 36.7% compliance for Question 2 and 23.3% compliance for Question 3. 66.7% included detail of follow-up actions and clinical decisions based on responses to the questions that were asked. Conclusion Primary care physiotherapists do not routinely ask the 3KQ during an initial assessment. Interventions post audit include: inclusion of the 3KQ on physiotherapy assessment forms; a copy of the World Fall Guidelines Risk Stratification Algorithm displayed in treatment rooms; and guidance for staff on where to refer patients for further assessment/intervention if required.