less restraint less fall - hospital authority · less restraint less fall project ... involved...
TRANSCRIPT
LESS RESTRAINT LESS FALL PROJECT
IN KH
Hospital Authority Convention 2017
Oral Presentation, F 2.1 KHCND APN Joanna LAI 1
Preparation work in
2014
Started Literature
review
Interviewed patients & involved staff after falls
for 3 months
Reviewed the current fall preventive
measures / devices
Reviewed the falls’ underlying causes &
common factors from 2012 to 2014
Listed out those high fall rate and PR rate’s clinical wards
Discussed with others professional in
a multidisciplinary approach
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Suggested Interventions from Literatures Establish a restraint reduction committee Ensure a multidisciplinary collaboration Educate staff and families Identify the restraint high usage areas as the
target areas and implement the program Establish a supportive/ consultation team to
work with the nursing staff Develop and implement an interdisciplinary
restraint assessment form Scheme a restraint-free care training program
Kwok T et al. (2012) & Anonymous. ProQuest (2000)
Offer bed alarms as one of the PR alternative measures
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Before we
start
Time
Scope
Resource
Quality Risk
Stake-holders
Communication
Copyright © 2017 Knowledge Century Ltd. 6
1. Formed a Multidisciplinary Work Group
• Leaded by GM(N)
• Lobbied COS of REH, DM of PT and OT to form a work group to target less restraint less fall
• Met for sharing and discussion every 3 months at the beginning
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2. Acknowledged the Risk on Less Restraint
• Predicted that may has an upward number of falls afterwards • Reassured frontline staff may increase falls when try to release PR & coped with their stress • Should keep patient safety
Could decrease fall rate?! Or...
Release of PR
.
O T P T
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3. Safeguarded Quality Care & Patient Safety regarding Fall Prevention
• Strengthened a multidisciplinary approach – All recruited patients should be referred PT & OT to
reinforce the patients’ in hospital training and education on fall prevention
– Case doctor would pay more attentions on drug effects that causing dizziness / drowsiness / muscle weakness / instability / hypotension / bradycardia
– Ward nurses would focus on intermittently PR release, bed arrangement, fall preventive device applications, and education on fall prevention
• Developed a record & flow chart to guard frontline staffs through the project
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4. Kept Well Communication with Stakeholders and Frontline Staffs
• Shared data & discussed with
multidisciplinary members at
half-yearly meetings
• Provided on-site support to
frontline staffs by CND staff
thrice per week
• Initiated interdisciplinary round
monthly 10
5. Report on Project’s Progress
•To frontline staffs, supervisor & members – Timely
– Promptly
– Appropriately
•To evaluate the PR & fall rate half-yearly 11
-
Demographic & Cognitive Data of the Recruited Patients
No. of Patients (from Mar 2016 to Feb 2017) A Ward B Ward
Total samples for analysis 52 59
Successfully off PR before the patient discharged
16 (30 % success)
19 (32 % success)
Range of Age 57-93 65-100
Ratio of Male & Female 39:13 (75% Male)
40:19 (68% Male)
Range of Glasgow Coma Scale 7 - 15 (mean: 13.5)
12 - 15 (mean: 14)
Range of Mini Mental State Examination / Abbreviated Mental Test
1 - 29 / 0 - 4 (mean: 14 /2)
2 - 24 / 2 - 6 (mean: 15 / 4)
Range of Functional Independence Measure
24 - 126 (mean: 59.8)
19 - 102 (mean: 62)
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0
10
20
30
40
50
60
70
80
0%
5%
10%
15%
20%
25%
30%
35%
Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17
A: Prevalence PR Rate B: Prevalence PR RateA: No. of Total Patients B: No. of Total PatientsA: Trendline of Restraint Rate B: Trendline of Restraint Rate
Pre
vale
nce
PR
Rat
e (%
)
No.
of T
otal
Pat
ient
s
Monthly Prevalence PR Rate (checked by CND staff)
A ward Average:
23.3%
B ward Average:
23.7% 13
Monthly Prevalence PR Rate for Fall Prevention
(checked by CND staff)
0
10
20
30
40
50
60
70
80
0%
10%
20%
30%
40%
50%
60%
70%
80%
Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17
A:Prevalence PR Rate for fall prevention B:Prevalence PR Rate for fall preventionA: No. of Total Patients B: No. of Total PatientsA: Trendline of Restraint Rate B: Trendline of Restraint Rate
Res
trai
nt R
ate
(%)
No.
of T
otal
Pat
ient
s
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/l//////////////
Comparison of Annual Prevalence PR Rates for Fall
Prevention at KH (self-reporting)
Ward May 2014 (before the
project)
May 2015 (before the
project)
Mar 2016 – Feb 2017 Monthly Average
(checked by CND staff)
Lesser Prevalence PR Rate for
Fall Prevention
A 92.9% 93% 44.2%
B 47.4% 77.6% 28.2%
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Different Fall rates of Both Wards from Mar 2016 to Jan 2017
0.81 0.82 0.84 0.82
1.17
1.35
0.66
0.27
0.84
1.00 0.97
1.83
1.66
0.23
0.78
0.99
1.47 1.55
1.01
0.26
0.49
0.74
0
1
2
Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17
Previous Year Fall RateFall RatePrevious Year Fall Rate TrendFall Rate Trend
Fall
Rat
e, %
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Post Fall Severity Index (SI) from Mar 2016 to Feb 2017
SI 1 (6)
67%
SI 2 (2)
22%
SI 3 (1)
11%
SI 4 (0) 0%
Patients Recruited in the Project
SI 1 (26) 61%
SI 2 (15) 35%
SI 3 (1) 2%
SI 4 (1) 2%
Non Recruited Patients
SI 1 SI 2 SI 3 SI 4
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Acknowledge MR S Y KWAN, KCC DGM(N) / KH GM(N) DR Jennifer MYINT, KHREH COS DR Kenneth CHUNG, KHREH AC MS Olga MA, KH DOM(RM&E) MS K H TING, KHREH DOM(R&E) MR Walen LEUNG, KHREH RN MR Timothy WONG, KH SNO2 (NS&A / Q&S) MR K P PANG, KH WM (PSY) MS Alice LEUNG, KHREH WM & 2A Ward colleagues MS K H CHEUNG, KHREH WM & 3A Ward colleagues DR Serena NG, KHOT DM DR Rosanna CHAU, KHPT DM DR Bobby NG, KHOT SOT MS Irene CHAN, KHOT OTI MR Robert TANG, KHOT PTI MR S YEUNG, KHCND EA1
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References Anonymous. (2000). Fall Prevention without Restraints: A Project:: Long Term Management Care. Nursing Homes.49 (2), 38-41. Dyck, D., Thiele, T. & Kebicz, R. (2013). Hourly Rounding for Falls Prevention: A Change Initiative. Journal of Creative Nursing, 19 (3), 153-158. Gulpers, M. J.M., Bleijlevens, M. H.C., Capezuti, E., et al. (2012). Preventing Belt Restraint Use in Newly Admitted Residents in Nursing Homes: A quasi-experimental Study. International Journal of Nursing Studies, 49 1473- 1479. Hennessy, C. H., McNeely, E. A., Whittington, F. J., et al. (1997). Perceptions of Physical Restraint Use and Barriers to Restraint Reduction in A Long-term Care Facility. Journal of Aging Studies, 11 (1), 49-62. Kwok, T., Bai, X., Chui, M. Y.P., et al. (2012). Effect of Physical Reduction on Older Patients' Hospital Length of Stay. Journal of American Medical Directors Association, 13, 645-650. Lai, C. K.Y., Chow, S. K.Y., Suen, L. K. & Wong, I. Y.C (2013). Reduction of Physical Restraints on Patients during Hospitalization / Rehabilitation: a Clinical Trial. Asian Journal of Gerontology & Geriatrics, 8 (1), 38-43. Lai, C. K.,Y. Chow, S. K.Y., Suen, L. P. & Wong, I. Y.C. (2011, July 5). The Effect of a Restraint Reduction Program on Physical Restraint Rate in Rehabilitation Settings in Hong Kong. Rehabilitation Research and Practice, pp.1-9. Mccabe, D. E., Alvarez, C. D. & Mcnulty, R. (2010). Perceptions of Physical Restraints Use in the Elderly Among Registered Nurses and Nurses Assistants in a Single Acute Care Hospital. Journal of Geriatric Nursing, 32 (1), 39- 45. Shorr, R. I., Chandler, A. M., Mion, L. C., et al. (2012). Effects of an Intervention to Increase Ved Alarm Use to Prevent Falls in Hospitalized Patients. Annals of Internal Medicine, 157 (10), 692-699. Tolson, D. & Morley, M. (2012). Physical Restraints: Abusive and Harmful. Journal of American Medical Directors Association, 13, 311-313. Tzeng, H. M., Yin, C. Y. Anderson, A. & Prakask, A.(2012). Nursing Staff's Awareness of Keeping Beds in the Lowest Position to Prevent Falls and Fall Injuries in an Adult Acute Surgical Inpatient Care Setting. Journal of Medical- surgical Nursing, 21 (5), 271-274. Zwijsen, S. A, Depla, M. F.I.A., Niemeijer, A. R., et al. (2012). Surveillance Technology: An alternative to Physical Restraints? A qualitative Study among Professionals Working in Nursing Homes for People with Dementia. International Journal of Nursing Studies, 49 212-219.
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