fall risk reduction program building compliance and sustainability southlake regional health centre,...
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Fall Risk Reduction Program Building Compliance and Sustainability
Southlake Regional Health Centre, Newmarket, Ontario
Background
• Acute-Care Hospital with 400+ beds• Newmarket, Ontario• Complex medical rehab (10 beds) and complex
continuing care (24 beds) unit being studied• Interdisciplinary team in place with nursing, PT,
OT, SLP, Recreation Therapist, and Discharge Planner. MDs available.
• Patients needing long-term rehab and those awaiting placement in LTC
Project Aim
• Southlake will reduce the rate of falls by 10% to a rate of 7.1% and reduce the severity of injury by 50% by implementing all evidence-based care components as able by December 31, 2008.
• We will establish benchmarks for this patient population.
• We want staff to comply with the program expectations
• We want our program to be sustainable
Team Members• Sharon Desormeaux – unit manager• Susan King – unit nurse educator• Barbara Lloyd – Falls Program Leader• Jan Courts – unit champion – long term nurse on unit• Wendy Andrews and Rebecca Spence – nurses on
studied unit • Annie Hayward – discharge planner in emergency• Lynn Bonk – Occupational Therapist on Orthopaedic
unit
Changes TestedHuddle Concept – method of communicating
with staff
System for Gathering of Falls Data- from each nurse tracking individually to having unit champion to assist/reinforce and pass on to unit manager
Falls assessment, identifiers and interventions reminders
Other Changes Tested
• Environmental assessment of patients rooms – clutter, brakes on equipment,
• Mobility sheets – establish safe method of transfer/gait
• 4 Ps – Pain, positioning, potty and possessions
Measures chart audits to measure assessments done
environmental assessments to measure
identifiers in place - environmental assessments to assess bed in lowest position, room free of clutter, brakes on equipment
patient interviews to determine if 4 Ps performed by staff
staff report that there is an increased awareness of falls management on the unit and more attention to this
Comparison of Falls Rates/1000 Pt days
0
2
4
6
8
10
12
14
16
2007 - average 8.78 2008 - average 6.43
april
may
june
july
august
september
october
november
Comparison of Falls Rates/1000 patient days pre and post program implementation on CMR
0
2
4
6
8
10
12
14
16
2007/2008 - average8.18%
2008/2009 - average6.43%
april
may
june
july
august
september
october
november
december
january
february
march
Falls Rate per 1000 patient days
0
2
4
6
8
10
12
14
16
CMR - 2007/2008 -average 8.18%
CMR - 2008/2009 -average 6.43%
Hospital 2007/2008 -4.02%
Lessons Learned
Advice to other teams:• choose your time for change when staff will be
most receptive• Have a unit champion- who will keep initiative as
priority and constant resource• Unit reminders helpful
Key Insights:• Change is extremely hard to manage• Staying on task difficult with other priorities even
for improvement team• Ongoing measurement and assessment vital to
demonstrate successes and failures and provide impetus for ongoing change
:
Next Steps - implementation of post fall assessments- this
will give more insight into falls risk population on the unit and also current issues/systems affecting falls rate/injuries
- Information gained from post fall assessment may also help to direct future PDSAs
- Expanding support of unit champion to other units within hospital as able
- Consider set up of falls risk room or various ‘stations’ for staff for improved education and interest
Ongoing Steps
Ongoing reminders and reinforcement needed to keep momentum of change going- help sustain what we have
Work with front-line staff on unit to better determine needs of patients and staff for optimal outcomes- meetings, falls analysis
Ongoing implementation of PDSA cycles and engage the staff in successful outcomes
Staff need to work as a team and ‘own it’- continue to provide visual feedback
ChallengesStaff busy, meetings difficult to attendStaff perception that they are doing things ‘right’
and this is only creating more ‘work’Difficult connecting and communicating with
evening staff Huge volumes of paperwork in general so new
documents brought forward not well receivedPressing demands on management to fit in with
other responsibilities, including accreditationEnsuring follow through of change concepts
Challenges Handled
Hold bi-weekly meetings when unit champion available to discuss progress and make plans for next change concept
Post falls rate to demonstrate successes achieved Celebration in November as only 2 falls during month At least one member of management available at unit falls
meeting to support, encourage and plan appropriate PDSAs (unit manager, nurse educator and falls leader)
Minimizing any documentation for nurses– unit champion auditing and supporting follow through of change