Falls and Pressure Injuries Collaborative Learning Session 2 Title: Mercy Parklands Fall Prevention program Presenter: Helen Delmonte Organisation: Mercy Parklands

Mercy Parklands Private Hospital in Ellerslie: Mercy Care philosophy of person centred care, Mercy Mission and values and Spark of Life, focus on independence and engagement in a supportive environment 97 available beds: currently 14 of those residents are still at Rest Home level, and 5 YPD. Cognitive impairment: 50% of current residents have some level of cognitive impairment High Falls Risk: 69% of current residents are identified as High Falls Risk

Our team Helen Delmonte OT: Allied Health Manager and Falls Prevention Team Leader Catherine Heaney OT: Falls Prevention Coordinator Jennifer Ibanez CN: Pressure Injury Coordinator and Rounding Leader Physiotherapist, Mobility therapists and OT assistant Clinical manager and Charge nurses/RN’s HCA’s

Fall Prevention Program Policy and Procedures: based on Queensland Government Quality Improvement and Enhancement program; Best Practice Guidelines, Version 3, 2003. recent development of Project Charter and Driver diagram Assessment: on admission, following a fall, and 3monthly, identifies Low, Medium and High risk, with high risk alert identification Prevention/management strategy checklist and Profiling: guides care planning and interventions Education: increased numbers of staff receiving in service, including students and support staff( from 9 staff in 2010, 22 staff in 2011, to 40 staff so far in 2012) Promoting safety with residents and families through; Information brochure, awareness posters, Community and Family Focus Meetings.

Interventions – Multifaceted Approach Individual and Gp Exercises – Balance, Walking, Gym Individual resident handling wall charts Medication review and Vit D supplement, Environmental- declutter/reorganise room, bed/chair height, bell cord extension, visual, auditory and adaptive aids Restraint minimisation Hip protectors, non slip socks, supportive footwear Toileting regimes Behavioural management – Spark of Life Sensor alarms Resident/ family involvement Assistance Required badge Increased supervision and activity engagement

Fall profile What is it: Living document which includes all of the residents falls history – no of falls, location, times, fall trends (e.g. always in bedroom at night), trialled successful and non successful interventions, and the residents individual needs in relation to fall prevention( e.g. verbal prompts needed for orientation and use of walker, engagement in activity and increased supervision after evening meal) Criteria: following falls in consecutive months with one of those months having 2+ falls Implementation: Completed by Falls Coordinator and communicated to staff. Utilised most effectively as a quick reference care plan for individualised Fall prevention

40% of these residents have not had a fall in the past two months or more

Balance Group Balance Group: 2 x weekly exercises that focus on dynamic standing balance, lower limb muscle strengthening, upper limb stretches and breathing techniques Tinetti Balance assessment tool; at start and after 12 classes Results: Evaluations in July 2011 and July 2012 demonstrated benefits. In 2012 67% of consistent participants showed an improvement or maintenance in their Tinetti balance score with an average of 1 fall per participant per year. 72% of the non regular participants showed a decline in their Tinetti score with an average of 4 falls per participant per year

Proactive rounding Intentional rounding: Proactive rounding implemented in 1 wing in Aug 2012, initially 2hrly for 13 residents across all shifts, and then increasing to 1hrly 1 month later. Staff engagement: Initially high disengagement “ Don’t have Time” Compliance rate: week 1 - 64%, week 3 - 87%, week 9 – 90% Results: Still early days with no significant change in falls yet but now high staff ownership of the initiative as planning was done collaboratively at all times. Staff discussing more about why the fall occurred, how it could have been prevented. Significant reduction in number and time of call bells. Increased patient and family satisfaction, no complaints

Redevelopment of stand alone unit: Environment Redevelopment of stand alone unit: W2 -“ home environment” for residents with dementia and risk factors- falls, wandering, challenging behaviour. Bedrooms are close to lounge/dining area, no traditional nursing station, staff in area with residents at all times, l consistent staffing trained in Spark of Life, increased engagement in activities High Falls risk: 11 of 13 residents are identified as High Falls risk . Use of Falls profiling, identified risk times for serial fallers Results: 3mths operational, increased staff confidence and skills, improved management of resident risk behaviours. Results for Oct 2012 – 1 Fall, 0 behavioural incidents.

What we have learnt From the previous Learning session we have found the use of PDSA cycles and smaller snapshots of trials has enabled us to make quicker evaluations of results and implementation of subsequent further actions if needed- wish we had this session earlier! Quicker evaluation and followup improves results Staff engagement is essential, but hard work, we have seen a definite increase in staff awareness of fall prevention and a desire to achieve results Our learning and increased use of data analysis has improved our ability to understand and gain meaningful information from our data capture- still learning the different charts!

Results

Falls with major harm SAC not previously used prior to Jan 2012 so unable to directly compare previous years falls with harm However in 2011 we achieved a 36.4% decrease in fractures resulting from falls compared to 2010 2012 – currently level with 2011 numbers so need to intensify our efforts to maintain that for this year

The Future Further development of the team into “Preceptors” (specifically RN’s and HCA’s) to increase ownership of the program, sense of achievement ,assist with improvement initiatives, and improve timeframes Rounding to roll out to all wings Investigation of further developments throughout the facility to enhance and support person centred care in a safe and caring environment – learning from W2