Implementing a Falls Prevention Programme in the Acute

Implementing a Falls Prevention Programme in the Acute Hospital Setting Ms Pauline Fordyce, Head of Quality & Safety Ms Helen Ryan, Clinical Governance/Quality Manager Ms Joan Naughton, CNS Gerontology Liaison Beaumont Hospital Dublin

Beaumont Hospital �Level 4 Hospital �National Specialities �Renal/Kidney Transplant Services �Neurosurgical Services �Tertiary Referral Hospital

RCSI Hospital Group Monaghan Cavan Dundalk Drogheda Beaumont Connolly Rotunda

Beaumont Hospital � Serve a population of 1, 022, 184 � Showing a largest population increase of any of the HSE 4 regions since 2006 � 1997 only 5% of Dublin’s over 65 lived in our catchment � Increased significantly to 24% by 2011 � 85+ age group increased by 20%between 2006 to 2011 � Beaumont Catchment increased by 60%

Supporting Structures for Falls Prevention � Quality and Safety enabling structures � Governance and Risk Committee of the Board ◦ Clinical Governance Committee ◦ Integrated Quality and Safety Committee; IQS Department (Patient and Staff Safety Model) ◦ Directorate Model of Care; 7 Directorates ◦ Local Directorate Clinical Governance Committee ◦ Falls Group � SCA stats in 2012 for a 5 year period indicated that we were in the median range for the number of adverse clinical events reported per bed day with our Peer Group (hospitals that has a similar number of beds)

Where to start ? ? ?

Find a few friends !!

Falls Group Who did we need around the table ? ü Nursing Representation ü Medical Representation ü Health & Social Care Representation ü Integrated Quality & Safety Representation ü Any others ? ?

Falls Group Terms of Reference Ø Background Ø Purpose Ø Roles and Responsibilities Ø Objectives and work plan Ø Reporting relationships/Governance arrangements

Knowing how we are doing !

Clinical Audit – Hospital Wide ü Methodology ü Audit tool ü Timeframe ü Audit Report

Study the results – What is the data telling us ?

42% of Falls Risk Assessments were completed for patients aged 65 years or older on admission

Opportunity for Improvement Review current policy - q. Review evidence q. Draft policy q. Consultation q. Agree final draft

Inpatient Falls Prevention Policy Framework ü Falls Risk Assessment ü Risk Of Falling Care Plan ü Patient/Family/Carer Information Leaflet ü SOP for the use of bedrails ü Post Fall Management Pathway

Falls Risk Assessment STRATIFY is a risk assessment tool developed to predict patients at high risk of falling with clinically useful sensitivity and specificity.

Risk of Falling Care Plan designed by the group �Individualised for each patient ◦ Documented date of assessment and reassessment ◦ Prompted alerting medical team of risk ◦ Referral to HSCP ◦ Identify the necessary interventions to be undertaken to ensure risk reduction.

Trying to make things better!!!

QI Methodology PDSA Cycle Act • What changes are to be made? • Next cycle? Study Plan • Objective • Questions and predictions (why) • Plan to carry out the cycle (who, what, where, when) Do • Complete the • Carry out the plan analysis of the data • Document problems • Compare data to and unexpected predictions observations • Summarize what • Begin analysis was learned of the data Model For Improvement

Patient/Family/Carer Information leaflet

Use of Bedrails MENTAL STATE 1)AGITATED/CONFUSED OR UNPREDICTABLE BE A) IMMOBILE B) LIMITED MOBILITY C) INDEPENDENT Patient is immobile (bed fast or hoist dependant) Requires some assistance i. e. 1 -2 people and mobility aid Patient can mobilise without help from staff Use Bedrails with care Bed rails NOT recommended 2) DISORIENTATION E. G FLUCTUATING CONSCIOUS LEVELS Bedrails may be used Use Bedrails with care Bed rails NOT recommended 3) ORIENTATED, ALERT AND ABLE TO SUMMON ASSISTANCE IF REQUIRED Bedrails may be used Bed rails NOT recommended HAVIOUR 4) PATIENT IS UNCONCIOUS Bedrails may be used Ref : National Patient Safety Association (NPSA)

Post Fall Management

Inpatient Falls Prevention Policy ü New policy agreed at Falls Group ü Ratified ü Upload by the Senior Management Team onto Q Pulse

Implementation Plan

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Communication 0 0 30 800+ Ov ff !! sta er 25 wa rd a patie rea nts!! ! s!!! 2 si ! ! tes

Inpatient Falls Prevention Policy Implementation Plan - Communication Ward walk around üVisibility of Falls Group üMeet with key staff üCirculate information üReceive feedback on opportunities/challenges üLearning

Inpatient Falls Prevention Policy Implementation Plan - Communication Awareness Campaign üScreensavers üPosters üStand outside Staff Restaurant/Quiz - Prizes üNewsletter üIntranet News and Announcements

Monitoring & Evaluation Quality Care-Metrics measure of the quality of nursing and midwifery clinical care processes aligned to evidenced based standards.

Monitoring & Evaluation 2015 87% 2013 42% Falls Risk Assessments

Next Steps ……. . �Review Current Policy !! �Learning �Quality Improvement Methodology �Collaboration