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Rapid Fire Team PresentationEdmonton Home Care


Falls Facilitated Learning Series

Alberta Health ServicesContinuing Care ServicesHome Care, Geriatric Consult TeamEdmonton, Alberta, Canada

Who We Are

• Home Living Program consists of Home Care, Day Programs, and several specialty programs

• Home Living serves 32,725 unique clients annually in Edmonton Zone

• Geriatric Consult Team was created in August, 2011, in part to provide assessment and treatment of clients who have a risk or history of falls

• 64 clients have been served as of February 29, 2012


Falls Facilitated Learning Series Objective of Learning Series

• Think critically about how the Geriatric Consult Team will achieve improvement in falls screening, falls prevention, and injury reduction

• Learn strategies of sustainability and integrate into falls improvement plans within overall Home Living Falls Risk Management Strategy

• Develop skills to sustain practice change for prevention of falls and injury reduction

• Actively participate in data submission to SHN Falls Intervention and network with other teams in the national Falls Facilitated Learning Series (FFLS)


Falls Facilitated Learning Series Working Team

Team Lead: Deb Payne, Manager, Quality Initiatives and Program Support

Team Sponsor: Dennie Hycha, Director, Home Living

Team Members: Shelley MacGregor, Area Manager, Geriatric Consult Team

Erin Meikle, Professional Practice Leader, PT, Home Living

Jennifer Russill, PT Amarjit Mann, PT Sandy MacLean, OT Sharon Weleschuk, OT Kelly Frazer, TA Richard Flierl, TA Sharon Storey, RN Winona Mondor, RN

Susan Haggerty, Pharmacist Lesley MacGregor, NPJoshua Running, NP Laura Murray, Recreation Therapist


Falls Facilitated Learning Series Changes tested to dateChanges Implemented Result Facilitators/BarriersCommunity Care Access (CCA) completes 3 screening questions on intake to Home Living • Have you fallen in the past 90 days?• If so, how many times?• Does fear of falling limit your activities?

94% of clients referred had falls screening on intake.

Facilitators: • Script is provided to all CCA staff –

approach is standardized• CCA staff were early adopters of

Home Care Falls StrategyBarriers:• None

Falls screening by Home Living Case Manager

Partially working. Facilitators: • Falls Strategy is now a provincial

initiative• Strong leadership locally and

provincially• Completion of Phase I resulted in

creation of Geriatric Consult Team, moving more to client focus

Barriers: • Organization-wide transition from

paper to electronic documentation system (Meditech)

• High workload of Case Managers


Falls Facilitated Learning Series Changes tested to date

Changes Implemented Result Facilitators/BarriersGeriatric Consult Team Assessment Tool including SPLATT•SPLATT questionnaire provides details about circumstances around fall (Symptoms, Previous falls, Location, Activity, Time, and Trauma)

Partially working. Facilitators: • Ease of administration of SPLATT• Background knowledge of Phase I to

guide team• Knowledge and support from Falls

Risk Management Implementation and Evaluation Committee

• Standard of Care for client falls is currently being piloted

Barriers: • Evolving processes for Geriatric

Consult Team to assess falls or falls risk once screening is positive; awaiting Standard of Care



Baseline Measures• A chart review of Geriatric Consult Team clients was conducted in

September, 2011

• Geriatric Consult Team adopted FFLS goals for study period

Actual Goal from Team Charter

Percentage of Falls Causing Injury 30% 24%(reduce by 20%)

Percentage of Clients with Complete Falls Risk Screening on Admission 90% 100%

Percentage with Documented Falls Prevention/Injury Reduction Plan 70% 100%



Client Group Home Living clients referred by Case Managers to Geriatric Consult Team

Study Period September 1, 2011 to January 31, 2012

Clients assessed and admitted to Geriatric Consult Team

43

Study Population


Falls Facilitated Learning Series Study Results



• Clients referred to Geriatric Consult Team are often already experiencing falls or have a significant risk of falls

• Geriatric Consult Team has no influence over the number of clients who have experienced a fall causing injury on admission to the team

• Assessments may be delayed due to:• Client availability• Team availability• Increase referrals to Geriatric Consult Team

• Monthly reporting does not provide trend data, only episodic data

Factors Affecting Monthly Data



• Continue to visit new clients as soon as possible and include falls screening on initial visit

• Aim to complete documentation about falls history and risks in a timely manner

• Review reporting periods to mitigate effect of delayed assessment

• Identify cases where external factors delayed falls screening

• Periodic review with Geriatric Consult Team and peers to discuss processes to work towards relevant data collection and best practice

• Create standardized template and database for reporting of Geriatric Consult Team clients’ falls

Ensuring Quality Data


Falls Facilitated Learning Series Geriatric Consult Team Feedback: Falls

• 18 out of 64 clients have experienced a fall while under the care of Geriatric Consult Team from inception to February 29. 2012

• Geriatric Consult Team is aware of the need to collect data about number and circumstances of falls in addition to Home Living falls reporting system

• Family members and Home Care Case Managers report high satisfaction with Geriatric Consult Team’s interventions

• Geriatric Consult Team members appreciate the benefit of an interdisciplinary approach to falls



• Geriatric Consult Team evaluated its current comprehensive initial assessment tool to determine its usefulness in falls screening and evaluation

• PDSA cycle determined that the assessment tool in combination with the screening questions and SPLATT was an adequate screening tool, but additional targeted assessments should be explored for further evaluation of falls and falls risk

• Geriatric Consult Team is exploring documents available in Meditech to assist in interdisciplinary assessment of falls

• Geriatric Consult Team is working in collaboration with Falls Risk Management Implementation and Evaluation Team to standardize interventions for clients at low and high risk for falls

Plan, Do, Study, Act (PDSA) Cycle



• Competing priorities in Alberta Health Services

• Geriatric Consult Team is a new entity, therefore, its processes and assessment forms are evolving

• Uncertainty amongst Geriatric Consult Team members as to how to proceed following falls screening

Sustaining Falls Improvement: Barriers


Falls Facilitated Learning Series Sustaining Falls Improvement: Facilitators

• Strong support of Alberta Health Services, Senior Management, and Falls Risk Management Implementation and Evaluation Committee

• Involvement with Canadian Falls Prevention Curriculum has provided Canadian content and is evidence informed

• Geriatric Consult Team is a small, interdisciplinary group of experienced professionals who can directly impact the multifactorial reasons clients fall

• Geriatric Consult Team has the opportunity to create new processes without the change management challenges that occur in a larger organization



• Ensure timely assessment of clients, completeness of falls screening and appropriate, interdisciplinary evaluation of falls

• Fully implement Standard of Care for falls

• Determine an evaluation tool for Geriatric Consult Team clients who acknowledge a history of falls

• Develop database and tracking form for Geriatric Consult Team to record clients’ falls

• Collaboration with Falls Risk Management Implementation and Evaluation Committee

Sustaining Falls Improvement: Moving Forward



Sustaining Falls Improvement: Key Insights

• FFLS was beneficial in initiating discussion on a Standard of Care for falls

• Participating in FFLS has reinforced that falls are a universal problem and Geriatric Consult Team has benefitted from other teams’ knowledge

• Process needs to be straightforward and implemented by all team members

• Initial Geriatric Consult Team’s success is facilitated by team members visiting clients frequently and responding in a timely manner

• FFLS process has provided insight into Geriatric Consult Team’s role in Home Care at large


Falls Facilitated Learning Series Sustaining Falls Improvement: Advice to Teams

• Keep working team small

• Focus on one problem at a time

• Align with larger organizational goals and find supportive leaders in management

• Learn from other teams’ success and challenges



6 Month Post FFLS Sustainability Plans for Falls Improvement

Goal Description Action Person Responsible Metrics Targeted Completion

100% of clients will have falls screening completed on intake to Home Care

3 falls screening questions

Community Care Access Monitor completion of screening through chart audits

Annual process evaluation

100% of Home Care clients will have falls risk screening by Case Manager on initial assessment

Completion of FROP-COM in Meditech

Home Living Case Managers

Meditech chart audits Annual process evaluation

Implement organization-wide Standards of Care for falls

Compile data based on pilot project to develop Standards of Care

Falls Risk Management Implementation and Evaluation Committee

TBD April 2012

Develop Standard of Care for referral to Geriatric Consult Team based on risk stratification

Determine criteria for high-risk clients that will indicate referral to Geriatric Consult Team; establish process for screening and assessment

Geriatric Consult Team, Falls Risk Management Implementation and Evaluation Committee, Program Support Manager

TBD Fall 2012



6 Month Post FFLS Sustainability Plans for Falls Improvement

Goal Description Action Person Responsible Metrics Targeted Completion

Geriatric Consult Team to determine effective falls assessment tool

Review assessments available in Meditech

Geriatric Consult Team and Meditech support personnel

Qualitative review by Geriatric Consult Team

April 2012

100% of clients will be screened for falls risk by Geriatric Consult Team on initial assessment

Repeat 3 falls screening questions and administer SPLATT

Geriatric Consult Team Meditech and chart audits

Quarterly data collection; annual process evaluation

100% of Geriatric Consult Team clients will have falls prevention/ injury reduction plans

Establish plans when creating problem list based on assessment

Geriatric Consult Team Meditech and chart audits

Quarterly data collection; annual process evaluation

Reliably record falls of Geriatric Consult Team clients

Establish tracking form for Geriatric Consult Team clients re: falls

Geriatric Consult Team Database to monitor frequency of falls post-assessment

April 2012; quarterly data collection



Deb Payne, MScHPManager, Quality Initiatives and Program SupportPhone: (780)-735-3354Email: [email protected]

Jennifer Russill, BScPTPhysical Therapist, Geriatric Consult TeamPhone: (780)-408-5973Email:[email protected]

Contact Information

mailto:[email protected]

mailto:[email protected]

rapid fire team presentation edmonton home care

Documents

prevention of falls

falls improvement

client falls

previous falls

national falls

home living team members

specialty programs home

home living jennifer