Preventing Falls in Hospitals (Slide Presentation)

A Toolkit for Improving Quality of Care

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Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care

Agency for Healthcare Research & Quality
Toolkit: http://www.ahrq.gov/professionals/systems/long-term-care/fallpxtoolkit/index.html
William Spector, PhD

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What’s New?

  • Falls Prevention Toolkit for Hospitals
    • Web based design
    • Evidence-based tools for falls prevention (35 tools)
    • Guidance for multidisciplinary change team
    • Focuses on overcoming the challenges associated with developing, implementing, and sustaining a fall prevention program
    • Developed by RAND Corporation, ECRI Institute, and Boston University for AHRQ

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David Ganz, MD, PhD
RAND Corporation

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Purpose of this project

  • Develop text and tools to guide implementation and maintenance of a hospital fall prevention program
    • Audience: mid-level managers and clinicians
    • Coverage: all stages of organizational change
  • Reference for hospital teams at different levels of sophistication
  • Approaches adaptable to local circumstances

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Toolkit/Resource Guide

  • Six sections:
    • Hospital readiness for change
    • Managing change
    • Choosing fall prevention practices
    • Implementing best practices
    • Measuring fall rates and fall prevention practices
    • Program sustainability

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Inputs to toolkit

  • Evidence review
  • Expert panel
    • In person meeting + follow-up conference call
  • Hospital workgroup
    • Self-assessment + follow-up phone call
    • In-person meeting + monthly teleconferences
    • Tool evaluation forms
    • Site visits

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Hospital workgroup

  • Six hospitals
    • Vary on geography, safety net status, profit/non-profit, unionization, use of electronic health record
    • Units selected for piloting:
      • Medicine
      • Neurology/neurosurgery
      • Progressive care unit (telemetry/post-cath)
      • Inpatient rehabilitation
      • Geriatric psychiatry

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Kathryn M. PelczarskiECRI Institute

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Fall Prevention Tools

  • Tailored with input from the pilot hospitals to ensure tools are:
    • Realistically implementable
    • Easy to use
    • Broadly applicable in the acute care setting
  • Highly relevant to addressing common challenges

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Relevant Tools

Flowchart showing the following text boxes: Challenges leads to Opportunity leads to Tools That Really Help

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Challenge

Image of Atlas holding the world on his shoulders. This depicts Atlas Syndrome (taking the burden on alone), which is unlikely to succeed.

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Opportunity

  • An interdisciplinary approach
    • Essential input from key stakeholders
    • Harnessing the power of collaboration
    • Securing support and resources
    • Gaining buy-in
    • Shared ownership

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Tool: Interdisciplinary Team (2A)

Part I: Team Members

Image of tool to list in table form the Position/Discipline, Names of Potential Implementation Team Members From Each Area, and Area of Expertise.

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Tool: Interdisciplinary Team (2A)

Part 3: Matrix of Applicable Tools by Role

Image of tool to list in matrix form the Position/Discipline and corresponding Tools and Resources. For example, for Nurse Manager, an X is noted for Tool 3E to show that it applies to that position.

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Tool: Action Plan (2F)

Improvement Objective: Implement standard fall prevention practices within 6 months

Image of tool in table form showing Key Interventions/Tasks, Steps To Complete Task and Tools to Use, Team Members Responsible for Task Completion, and Target Date for Completion.

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Tool: Managing Change Checklist (2G)

Image of checklist with several tasks checked off: Implementation Team composition, Team leader identified and in place, Members with necessary expertise/role identified and invited, Team agenda and charge clearly stated, and Current state of fall prevention practice and knowledge assessed.

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Tool: Managing Change Checklist (2G) continued

Image of checklist with additional tasks listed and Staff knowledge assessed checked off.

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Challenge

Inadequate Risk Assessments and Reassessments

Image of young man with clipboard and image of rubber stamp

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Opportunity

  • Accurate and effective risk assessments
  • Employing critical thinking and clinical judgment
  • Consistency in approach
  • Identifying and communicating risk at the earliest possible time

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Tools

  • Morse Fall Scale (3H)
  • STRATIFY Scale (3G)
  • Medication Fall Risk Scale (3I)
  • Orthostatic Vital Sign Measurement (3F)
  • Delirium Evaluation Bundle (3J)

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Challenge

Inadequate and ineffective interventions

Morse Fall Score = 70

One set of interventions does not fit all

Over-reliance on bed exit alarms

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Opportunity

  • Optimizing the effectiveness of interventions
    • Tailoring interventions to address individual risk factors
    • Assessing their effectiveness
    • Modifying interventions, as appropriate

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Tool: Sample Care Plan (3M)

Image of tool showing columns for goal and action taken.

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Tool: Algorithm for Mobilizing Patients (3K)

Image of flowchart for mobilizing patients, including steps to take and inclusion and exclusion criteria.

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Challenge

Inconsistent or Ineffective rounds to address personal needs

Picture of patient lying in bed hooked up to an IV line. Pictures of items patient needs to reach: TV remote, eyeglasses, toilet, box of tissues.

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Opportunity

  • Consistent and effective rounds to address a patient’s personal needs
    • Purposeful rounding
    • Standardized inclusion of key elements
    • Optimizing safety during rounds

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Tool: Scheduled Rounding Protocol (3B)

Image of tool showing items in protocol, such as offering toileting assistance and checking that the bed is locked.

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Challenge

Unable to sustain falls prevention

Graph with on falls and falls with injury. A Falls Prevention Initiative took place in 2009. Falls and falls with injury decreased from 2008 to 2009 but increased in 2010 and 2011.

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Opportunity

  • Continuous Improvement
  • Identifying and addressing process challenges
  • Improving compliance
  • Learning from near falls and falls that do not involve harm, in addition to learning from falls with harm

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Tools

  • Assessing Fall Prevention Care Processes (5B)
  • Postfall Assessment for Root Cause Analysis (3O)
  • Information to Include in Incident Reports (5A)
  • Measuring Progress Checklist (5C)
  • Sustainability Tool (6A)

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Tool Roadmap

Image of roadmap showing Section, Action Steps, Tool That Supports Action, and Who Should Use the Tool.

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Pilot Hospitals

 

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Charlton Memorial Hospital

Fall River, Massachusetts

Kendra Belken, PT, DPT

Physical Therapy Practice Specialist

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Falls Knowledge Test (2E)

  • Employees with various job functions in the Rehab Unit completed the test
  • Tool was revised based on our input to provide more clarity in instructions and question format
  • Results helped us to target education to address gaps in staff knowledge
  • Environmental safety
  • Medications associated with risk of falls

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Assessing Fall Prevention Care Processes (5B)

  • Tailored tool by grouping required information by location (e.g., environmental safety information in patient room, patient chart information at nurse’s station) --- reduced required audit time
  •  Added elements for patient room assessment (e.g., hourly rounding log complete)
  • Helped monitor progress
  • Plan to roll out this audit tool for use by fall prevention champions in all units

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Augusta Health

Fishersville, Virginia

Pat Benson, BSN, RN-BC

Nursing Quality Coordinator

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Environmental Safety Inspection List (3C)

  • Added picture of typical patient room to show optimum environmental set-up corresponding to items on checklist
  • Used by environmental services and nursing

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Environmental Safety Inspection List (3C)

  • Audit identified problems with bed function & provided justification for implementing bed replacement plan
  • Incorporated in Post-Fall Assessment for Root Cause Analysis Tool to investigate environmental safety issues that may have contributed to patient fall

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Thanks

Page last reviewed May 2013
Internet Citation: Preventing Falls in Hospitals (Slide Presentation): A Toolkit for Improving Quality of Care. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/webinar/fallspxtoolkitwebinarsl.html