Fall Prevention Fareen Ahmed Chris Chien Zaira Masood

Fall Prevention Fareen Ahmed Chris Chien Zaira Masood Mary Randolph Tiani Tuiolosega

• An incident that results in a person coming to rest inadvertently on the ground or floor or other lower level. • Patient falls, defined as the rate at which patients fall during their hospital stays per 1, 000 patient days, are a nursing-sensitive quality indicator in the delivery of inpatient services. • Patient fall rates are perceived as the indicator that could be most improved through nurse-led safety strategies or interventions. • In other words, nurses assume the primary responsibility and are somewhat liable when a patient falls in the inpatient care unit. Definition of a Fall

• According to reports published by the Centers for Disease Control and Prevention Injury Center (2007), patient falls are the: • Third most common cause of unintentional injury death across all age groups. • First leading cause among people 65 years and older. Background

• Sun Coast Regional Hospital is a 500 bed, full service, acute care facility with a medical staff of approximately 1, 100 and employee base of 1, 500. Facility Information

• Number of Patient Falls / Number of Patient Days x 1, 000 = Fall Rate per 1, 000 patients. • Currently, the risk of inpatient falls is 50% per 1, 000 patients annually. Problem

• We are a quality improvement team which has been brought in by Sun Coast Regional Hospital to help reduce the risk of inpatient falls within their facility. • Our goal is to reduce the risk by 90%, resulting in 10% risk of inpatient falls per 1, 000 patients annually. Aim

Describing the Intervention

• All patients aged 65 and over. • Younger patients at increased risk of falling, such as those with: • • History of falls Neurological conditions Cognitive problems Visual impairment Patients to be Targeted for this Initiative

Fishbone Analysis

• 1) Screening or assessment of all older patients for risk of falling. • 2) Education and discussion of fall-prevention risks and strategies with all staff, older patients, and their caregivers. • 3) Recording fall-prevention education of staff, older patients, and their caregivers. • 4) Establishing a person’s mobility status and ensuring that they can mobilize safely. This can be done by several criteria. • 5) Encouraging participants in functional activities and exercise programs. Fall Prevention Interventions

• 6) Instructing older patients on how to use their medications safely when they are being discharged or transferred between departments/facilities. • 7) Making the environment safe by ensuring several things. • 8) Orientating the patient to the bed area, room, ward/unit facilities and how they can obtain assistance. • 9) Instructing and ensuring that older patients understand how to use care aids prior to them being prescribed. • 10) Having a policy in place to increase the use of restraints and bedside rails. • 11) Consider vitamin D supplementation with calcium as a routine management strategy. Fall Prevention Interventions

• A hospital can be a dangerous and erratic place for inpatients because: • Unfamiliar physical environment (different from that of their home setting). • Changes in patients' medical conditions as related to their physical and psychological health and sensory systems (e. g. , pain). Facility Design

• A better physical facility design may lead to better health care outcomes, such as fewer patient falls in acute care hospitals. • A patient-centered facility design should promote patient safety. • A safety-driven design with a goal to prevent inpatient fall related injuries should be a hospital design principle. Facility Design

• Increase patient to provider ratio. • Adding information regarding falls onto patients’ charts. Workforce

Patients Staff • Educate about how falls can impact health. • How and where to get assistance when being mobile. • Steps to prevent falls as a patient. • Educate and train in the use of various mobility aids. • Educate about how falls can impact health of patients. • How to assess patients’ risk regarding various diagnoses. • Steps to prevent patient falls. • Steps to take when patients do fall. Educating Patients & Staff

• Find an opportunity to improve • Organize a team • Clarify current understanding of process • Understanding the causes • Select an intervention(s) FOCUS

• Sun Coast Regional Hospital is faced with a large risk of patients falling in the facility each year. Currently, the fall rate is 50% per 1, 000 patients annually. • Falls can be devastating, especially for seniors. Fallrelated injuries may ensue and cause further negative health outcomes. • As the QI team, our plan is to reduce this number significantly by incorporating strategies that will help reduce the risk of patients falling. Find an Opportunity to Improve

• The QI team will consist of: • Team Leader: Oversees QI process and directs the team. • Nursing Staff: Assesses patients’ risk of falling, supervise and assist them with their mobility needs. • Data Technician: Records and updates information and continuously ensures team and patients are up-to-date with intervention strategies. • Facilities Manager: Oversees improvement of hospital design for patient safety and facility maintenance. • Compliance Officer: Ensures the team is complying within safe practices for patients when implementing interventions. Organize a

• The current process at Sun Coast is very poor and is often a reactive step which only takes place once patients have already suffered from a fall. • Falls are recorded any fall-related injuries are then treated promptly. • There are minimal preventative practices and procedures along with an insufficient amount of patient to provider ratio. • With such a poor process, the number of falls will continue to increase and no improvements will be made. Clarify current Understanding

• There are multiple causes that may trigger patients to fall during their stay in the hospital, and without proper oversight and preventative practices, falls will likely occur often. • As the quality improvement team, we have identified three (3) sources that contribute highly to the annual fall rate and which we shall address with interventions. • Materials (education of patients & staff) • Physical environment (facility design) • Workforce (staff increase) Understanding the Causes

Materials • Education and discussion of fall-prevention risks and strategies with all staff, patients, and their caregivers. Physical Environment • Making the environment safe by ensuring several things (i. e. , install more hand rails, clean and hazard-free floors, well-lit rooms, etc. ). Workforce • Orientating the patient to the bed area, room, or ward/unit facilities and how they can obtain assistance. Selecting the Intervention(s)

PDSA Cycle

PDSA

• Quarterly auditing of the implementation process. • Formula used: • The percentage of patients who received all fall prevention interventions can be calculated by: • Number of patients observed having ALL appropriate fall prevention strategies in place / Number of patients at risk reviewed x 100% = % Results. Measuremen t

Auditing Fall Prevention

Auditing Fall Prevention

• First quarter assessment: reduction of inpatient falls by 40% • Derived from formula: 200 / 500 x 100 = 40% of patients received all falls prevention interventions. • Second quarter assessment: reduction of inpatient falls by 50% • Third quarter assessment: reduction of inpatient falls by 70% • Fourth quarter assessment: reduction of inpatient falls by 90% Results

• Notice less improvement between first and second quarter assessments. • This was due to: • Patients not wearing proper footwear. • Patients not wearing blue wristbands. • Patients not seeing a physiotherapist for check-ups. Outcomes

• Enforce stricter rules regarding use of footwear and blue wristbands – check patients daily to make sure they have it on. • Schedule monthly routine check-ups with a physiotherapist for patients. Solution Implementation

• Failure Mode and Effects Analysis (FMEA) • Proactive risk assessment • Prevents an adverse event • Close examination of a process • To help determine where improvements are needed • Reduces likelihood of adverse affects • Process in terms of: • What could go wrong? • If something does go wrong, what will be the result? • What needs to be done to prevent a bad outcome when something does go wrong? • Hospitals and nursing facilities that are accredited by The Joint Commission are required to periodically conduct a prospective risk assessment for patient safety improvement. Risk Assessment

• Narrowed focus to three (3) main areas: • Materials: • Education for patients about falls • Education for employees • Physical environment: • Keeping the beds low under a certain degree • Open floor plan in bedrooms • Workforce: • Patient to provider ratio • Adding information to charts regarding falls • Annually conduct risk assessment with every department: • Set goals: • Current: Reduction of 90% • Ultimate: No falls • Audit charts Process

Risk Assess ment Templat e

Audit Tool: Questionnaire

Audit Tool: Diagram

• Sun Coast RH faces a high risk of patient fall rate of 50% per 1, 000 patients annually. • The QI team aims to reduce the risk by 90%. • Conduct a fishbone analysis to find multiple causes and settled on three (3) that were of great significance. • Completed the FOCUS-PDSA model. • Conduct a risk assessment of patients. • Measured results using a formula and obtained outcomes of the interventions. • Reinforce interventions for patient falls and continued with QI process. Conclusion