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Thank You for Joining!
Learning Series: Improving Nursing Home Resident
Mobility – Part II
New England Nursing Home Quality Care Collaborative
Webinar Will Begin Shortly.
Call-In Number: (888) 895-6448 Access Code: 5196001
Webinar Objectives
Learn strategies to help your residents improve their mobility and reduce falls
Become an alarm-free facility, overcome staff reactions, and sustain improvements
Develop a falls prevention program that includes hourly rounds, post fall assessments, and other resources
This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO), the Medicare Quality Improvement Organization for
New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents
presented do not necessarily reflect CMS policy CMSQINC22017081126.
FALLS VIRTUAL
BREAKTHROUGH SERIES
ACTION PHASE
FINAL TEAM REPORT
CHELSEA SOLDIERS’ HOME
CHELSEA, MA
Team Members and titles:
Dr. Jed Barash, Medical Director
Deb Antonelli, Director of Nursing
Lena DeMiles, Assistant Director of Nursing
Chad Morin, Compliance Officer
Mark Waksmonski, Nursing Supervisor
Shirley Kraft, Occupational Therapy
Donna Chan, Occupational Therapy
Teresa Dancewicz, Physical Therapy
Nursing team/others (too many to list)
TEAM NAME
Chelsea Soldiers’ Home, Chelsea MA
Our focus was entire facility initially, followed by
falls with major injury
BRIEF DESCRIPTION OF YOUR STATE
VETERAN HOME AND UNIT(S) WHERE YOU
FOCUSED YOUR EFFORTS.
The goal was to create a fall committee which
would work together to identify reason for falls,
whether it was environmental or medical. Critically
look at systems which contributed to falls.
Fall Committee meets twice weekly, review of event
as well as a chart review to identify needed
changes.
Post Fall- automatic referral to OT/PT for
assessment
RESTATE THE FINAL VERSION OF THE AIMS
YOUR TEAM DEVELOPED FOR THE PROJECT.
With each fal l
nursing staf f
wil l write
order for
PT/OT
consult ,
complete the
consult sheet
and submit to
rehab team
Multi system approach with following systems reviewed:
1 . Bowel and Bladder Program
2. Restorative Program
3. Psychotropic/Behavior Program
4. Review and updating policy and procedures as well as development of new assessment forms
5. Working through consistent assignment of staff
6. Worked on improving dining program and
realignment of staff during lunches which decreased falls pre and post meals.
7. introduced post fall huddle sheet
D E S C R I B E T H E C H A N G E S T H AT YO U R T E A M M A D E / A C T I O N S YO U I M P L E M E N T E D
D U R I N G T H E A C T I O N P H A S E O F T H E B R E A K T H R O U G H S E R I E S - P L E A S E S P E C I F Y I F
T H E S E A R E N E W O R M O D I F I E D C H A N G E S ( E X : M O D I F I E D P O S T FA L L H U D D L E F O R M V S .
D E V E L O P E D N E W E D U C AT I O N T O O L )
Two part goal:
1 . Our center was seeing as many as 75 falls per month.
Our primary goal was to reduce the number of falls
2. Our secondary goal was to reduce falls with major
injury. I am proud to state we reached this goal.
Team has maintained our fall program over the last 18
months with falls averaging monthly as follows:
1 . Low 6 falls
2. High 18 falls
3. Major reduction in minor and major injuries to our
Veterans
DESCRIBE ANY OUTCOME CHANGES YOU HAVE SEEN
SO FAR (FEEL FREE TO USE SOME OF THE GRAPHS
YOU HAVE DEVELOPED TO DEMONSTRATE THIS)
Refer to fall assessment tool
SHARE – SHARE ONE ACTION/CHANGE/TOOL YOU
DEVELOPED THAT YOU ARE PARTICULARLY PROUD OF
Challenges- keep staff engaged and focus on need
to continue critical interventions for patient safety
Despite training/re-education staff need continue
the importance of closely monitoring our patients
and addressing their five P’s
1. Pain
2. Potty
3. Position
4. Possession (items within reach)
5. Pump (obstacles)
OTHER LESSONS LEARNED
(NON-OUTCOME/PROCESS BASED LESSONS, TEAM LESSONS,
IMPLEMENTATION LESSONS, CHALLENGES)
The fall committee will continue to meet twice
weekly
Post Fall Huddle will be utilized post each fall and
reviewed by fall committee
Changes to processes or P & P to continue as needed
Intentional rounding (key factor) for fall reduction to
continue
DESCRIBE YOUR PLANS FOR CONTINUED WORK-
SUSTAINABILIT Y PHASE MOVING FORWARD
POST FALL
STAFF
STATEMENT/
AFTER
ACTION
REVIEW
BEDROOM –RM
DINING RM –DR
OFF WARD –OW
HALLWAY – HW
BATHROOM–BR
THERAPY-
OT/PT/KT
DAY RM- DAY
APPOINTMENT-
APT
PATIENTS’
LOCATION
August 31, 2017
We all have heard the story of the tortoise and the hare, after carefully
reviewing the amount of alarms we had; which was over 40, reviewing
our staff, as well as the residents and their families, I made the decision
to take the tortoise route; which was slow and methodical. It was a
longer process to finally achieve the end goal, but the overall outcome
resulted in a much more smoother and successful transition.
Step 1 - Education to the staff and Residents which included: all nursing
staff, housekeepers, dietary aides and recreation assistants, in addition
to the residents and their families (Note: some families may not buy into
the alarm reduction). My staff responded with “Flo are you crazy”
The education focused on the negative effects of alarms, alarms do not
prevent falls they often alert you to a fall
Alarms create noise, fear and confusion for the person and those
around them
Noise in the environment has been shown to be a primary contributor to
falls
If staff tell the resident to sit down when the alarm goes off, the
underlying need causing them to move is not being addressed
Alarms decrease resident’s overall mobility, increasing risk of
fracture when he/she falls due to increased weakness and
osteoporosis and decreased balance and endurance
Use of alarms is experienced as embarrassing and an infringement of
freedom, dignity and privacy
Alarms increase skin breakdown from immobilization; residents are afraid
to shift position
Loss of independent bowel and bladder function can occur
For cognitively impaired: induces agitation during the day and interrupts
sleep at night
Lack of sleep compounds agitation, and contributes to loss of appetite,
decreased balance and endurance
High degree of both false-positive as well as false-negative events
False alarms contribute to “alarm fatigue”, in which staff no longer responds
when an alarm appropriately sounds
An Effective Falls Prevention Program
Restorative Program which focuses on
strengthening
Interdisciplinary approach to falls
Quality of Life Rounds
C.N.A’s that are crossed trained to provide
recreational programs
Review all current alarms, set a goal to reduce x amount of alarms monthly
by a goal date
I.e.: if you have 24 alarms, reduce 4 a month for 6 months
Review each resident:
Their fall history, any patterns to their falls?
Are they still mobile?
Do they need a toileting plan?
Environmental factor-cluttered rooms, walker/wc placement
The initial residents you choose for reduction need to be successful so
choose carefully:
I.e.: a bed alarm on a resident that no longer has the ability to reposition themselves
Success with the initial reductions will enforce with staff that you are
headed in the right direction
Meet weekly with the team to inform them which resident and when they
will have their alarms removed.
Share the fall percentages, prior to beginning, what your goal % is, and as
you go through your alarm reduction journey
As an end result we have:
Peaceful units
Decreased agitation in residents
Increase in staff satisfaction due to the elimination of alarms.
Cost savings
Most importantly a reduction in falls and happier residents!!
Rader, Joanne, Barbara Frank, Cathie Brady. January 4,
2007. Rethinking the Use of Position Change Alarms.
Shorr, Ronald, MD, et al. Effects of an Intervention to
Increase Bed Alarm Use to Prevent Falls in Hospitalized
Patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269
Accessed 8-28-17
Willy, Betty, PT, MA and Christine M. Osterberg, RN.
Strategies for Reducing Falls in Long-Term Care.
http://www.annalsoflongtermcare.com/article/strategies-for-reducing-
falls-long-term-care
Accessed 8-28-17
Sutton, Brenda. August 6, 2014. Alarm Reduction
Florence Bolella RN
Genesis HealthCare Services
Kimberly Hall South
1 Emerson Drive
Windsor, CT 06095
Questions?
25
Contact your Nursing Home Quality Improvement State Lead
• Connecticut
Florence Johnson:
• Maine
Danielle Watford
• Massachusetts
Sarah Dereniuk:
• New Hampshire
Pamela Heckman:
• Rhode Island
Nelia Silva Odom:
• Vermont
Gail Harbour:
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Mark Your Calendars Upcoming NE-NHQCC Events
Designing an Antibiotic Stewardship Program for your LTC Facility
Sept 14th from 11:00am - noon
Webinar
Getting to the Root Causes of Resident Falls
Sept 21st from 8:30 am - 4:00 pm
In-Person Event: Wallingford, CT
Assessing and Managing Pain Seminar with Carol Curtiss
Sept 26th from 8:00 am - 2:30 pm
In-Person Event: Waltham, MA
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SEP
14
SEP
21
SEP
26
Mark Your Calendars
NEW! Facility Assessment Tool An optional template is available to help facilities comply with the new requirement that “Nursing facilities will conduct, document, and annually review a facility-wide assessment, which includes both their resident population and the resources the facility needs to care for their residents (§483.70(e))”.
Learn More on the next CMS MLN Connects Call
Thursday, Sept 7th from 1:30 – 3:00 PM
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And The Winner Is…
2 tickets to the in-person event
Getting to the Root Causes of Resident Falls
presented by SueAnn Gildermann in
Wallingford, CT on September 21st!
29
Win Complementary Entries to Our
Assessing and Managing Pain Seminar
To enter, like us on Facebook between August
31st and September 13th.
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The New England QIN-QIO Nursing Home Quality Care
Collaborative will choose two winners to attend this
conference presented by Carol P. Curtiss in Waltham, MA on
September 26th!
Each winner will receive 2 entries to the event. The winners
will be announced on our September 14th webinar.
Connect with the New England
QIN-QIO on Social Media!
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https://www.facebook.com/NEQINQIO/