improving falls rates through ‘patient focus’

Improving Falls Rates Through ‘Patient Focus’

Emily Raybould Ward Manager

Ward 37

Ward 37

• 22 bed male nephrology ward

• Acute/Chronic kidney damage

• Multiple co-morbidities

• High falls risk – BP, HB levels and metabolic abnormalities

• Intentional rounding introduced August 2010

Intentional Rounding

Observation 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 00:00

1.ORIENTATION Fully alert =FA,Mildly confused/ disorientated =MCSevere confusion = S Asleep = A

2.NURSE CALL WITHIN REACHIf you need me press this button.

3.POSITION/COMFORT Are you comfortable and pain free?

4.CONTINENCE Do you need to go to the toilet?

5.DRINK/MOUTHCARE Is your water jug full and in reach? Do you need assistance?

6.IS THERE ANYTHING ELSE I CAN DO?

INITIALS:

Name:

Hospital number:

Date:

INTENTIONAL ROUNDINGOBSERVATIONAL CHECKLIST (to be asked as appropriate)

Time

Data Review

• 71 falls from June 2010-June 2011

• Average age of patient who fell – 78 years

• 96% level 1 falls with no serious falls at level 3-4

• IQP model to review falls

Data – Number Of Falls

0

2

4

6

8

10

12

Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11

Falls Rounding

Data – Time Of Falls

0

1

2

3

4

5

Peak of falls between 5am and 7am

Aims And Measures

1. Improve patient experience

2. Collect patient feedback from QCR + Patient tracker

3. Eliminate avoidable falls

4. Meet patients needs

5. Reduce nurse call bell usage

Implementing ‘Patient Focus’Plan Nominate champions and plan meetings.

Do Define what you want to do. Review current practice. Pilot new tool

Study Review pilot data e.g. patient and staff feedback.

Act Amend tool / method based on feedback. Roll out with continuous feedback for improvement

‘Patient Focus’

Is there anything I can do?

A3 Report

The staff on ward 37 worked together to identify a way to reduce the number of falls occuring on this ward. We looked at the data to see whenever patients fell - what was the time? and what was the reason? We worked together to

develop a process we call 'Patient Focus'. This involves staff checking on patients at set times and asking - Is there anything I can do? Since introducing this change we have had less than 5 falls per month. We are currently working

on patient focus alloaction on late and night shifts to improve compliance.

How are we making the improvements?

Improvement target 4: to improve overall patient experience on ward 37 This reduced the number of call

bells needing answering between 8am - 4pm by

80%

reduction

Improvement Target 3: to reduce number of call bells (between 8am - 4pm)

overall aim - to improve patient experience by checking patients frequently

Improving falls through 'Patient Focus'

Improvement target 1: to ensure 'Patient Focus' occurs daily (>80% checks done)

Improvement target 2: to reduce number of falls

0

10

20

30

40

50

60

70

80

90

100

08

/08

/20

11

15

/08

/20

11

22

/08

/20

11

29

/08

/20

11

05

/09

/20

11

12

/09

/20

11

19

/09

/20

11

26

/09

/20

11

03

/10

/20

11

10

/10

/20

11

17

/10

/20

11

24

/10

/20

11

31

/10

/20

11

07

/11

/20

11

14

/11

/20

11

21

/11

/20

11

28

/11

/20

11

05

/12

/20

11

12

/12

/20

11

19

/12

/20

11

26

/12

/20

11

02

/01

/20

12

09

/01

/20

12

16

/01

/20

12

% a

chie

ved

number ofdays patientfocusoccurred

at least 80%of timescompleted

0

5

10

15

20

25

before after

Overall Quality

40%

50%

60%

70%

80%

90%

100%

12/1

0

01/1

1

02/1

1

03/1

1

04/1

1

05/1

1

06/1

1

07/1

1

08/1

1

09/1

1

10/1

1

11/1

1

12/1

1

Monitoring Patient Falls

0

5

10

15

20

25

30

35

40

12/1

0

01/1

1

02/1

1

03/1

1

04/1

1

05/1

1

06/1

1

07/1

1

08/1

1

09/1

1

10/1

1

11/1

1

12/1

1

Reducing Number Of Falls

0

2

4

6

8

10

12

Jun-10 Jul-10 Aug-10 Sep-10

Oct-10 Nov-10 Dec-10

Jan-11 Feb-11 Mar-11 Apr-11 May-11

Jun-11 Jul-11 Aug-11 Sep-11

Oct-11 Nov-11 Dec-11

Jan-12

Falls Rounding

Patient Focus

Data – Times Of Falls

Peak at evening shift

handover

What We Have Achieved

• Reduced falls - 14 falls (Aug 11 – Jan 12) compared to - 39 in same period last year

• Indirect consequences

• Positive feedback

• Continuous improvement journey

• Electronic system pilot

• Roll out programme

Thank You

Emily Raybould Ward Manager

Ward 37